Ijjliiii^llliir^ 



-or- 



"M. 










EFW 



Qass_JdG^M£> 



Book. 



PRESENTED BY 



I 



TO THE MEDICAL EXAMINERS 



OF 



The Connecticut Mutual Life Insurance Co. 



This leaflet is placed in your hands as an aid to 
Medical Examinations in addition to the revised edition 
of "SIEVEKING'S. MEDICAL ADVISER IX LIFE 
ASSURANCE," which is herewith or has been pre- 
viously forwarded to you. 

Attached to a fly-leaf of that book it may always be 
convenient for reference. 

These suggestions will also be found on the back of 
every application. 



Family History. — Where ages, causes of death, etc. , are 
unknown, or very uncertain, require the applicant to ascertain 
them for you, or, if this appears impracticable, endeavor at 
least to establish the general hereditary tendencies and longevity 
of the family, and that deaths were not caused by any trans- 
missible disease, as consumption insanity, paralysis, apoplexy, 
or heart disease. 



Personal History and Examination. — Ascertain and 
state whether his various ailments, injuries, etc., have been 
trivial or severe and whether they have left any injurious 
effect. To the questions regarding vaccination, rupture, 
tumors, deformity, malformation, and injury, your reply, 
after careful inspection, is desired. 

Special attention is directed to the necessity of a very 
thorough and critical exploration of the chest for the detection 
of incipient disease. Never be satisfied simply with the 
absence of abnormal conditions, as rales and murmurs, but be 
equally positive of the presence of the normal. 

The Applicant's Habits regarding the use of alcoholic 
stimulants, opium, and tobacco should be definitely ascer- 
tained, and in stating them in your Report avoid the use of 
such words as "moderate," "occasional,"' and "temperate." 
Where their daily or frequent use is suspected assure yourself 
that the stomach, liver, kidneys, and nervous system are free 
from any evidence of injury. 

Urinalysis is always required, and, for the aid of any who 
may desire it, brief rules are given below. Various tests, 
aside from those detailed below, are considered trustworthy, 
but the ones mentioned are easily applied and sufficiently 
accurate. If others are used, state in your Report what test 
was employed. 

The Microscope should always be used when, in a case 
otherwise acceptable, there is a suspicion of disease requiring its 
aid for assurance, as where there is a history of calculus, or 
cystitis, 

It may occasionally occur that the information elicited will 
be of such a character that the Examiner will hesitate to place 
it upon the Report as fully as is desirable. In these cases we 
invite correspondence with the Consulting Ph}sician at the 
Home Office, where all such communications are held strictly 
confidential ; and in any case where the applicant requests it, 
or the Examiner deems it advisable, the Report may be sealed 
in envelopes supplied for that purpose before being delivered 
to the Agent for transmission to us. 



BRIEF EULES FOR URINALYSIS. 

Be sure that the urine is that of the applicant and examine 

it within 24 hours after it is voided. After noting the color, 

reaction, and specific gravity, fill a clean test-tube half full of 

the clear urine (previously filtered if turbid), and holding it at 

an angle of 45 degrees, allow nitric acid to trickle gently down 

its side and form a stratum, under the urine, at the bottom of 

the tube. If carefully done the two fluids will not mingle. 

Should any hazy or whitish cloud be observed at the point 

where the urine and acid meet, apply heat, and if the cloud 

remains albumen may be considered present. 

Note: Urine containing resinous matters, as when a patient is taking 
turpentine, balsam copaiva, etc., will sometimes give a whitish-yellow 
cloudiness, similar to albumen, with nitric and hydrochloric acids. The 
addition of alcohol will cause this to disappear at once. 

It is important to hold the test-tube in a proper light in 
order to distinguish slight changes, where only a small 
amount of albumen is present. The best way is that advised 
by Dr. John Munn, viz. : Place some dark material over the 
lower part of the window, as a background, and draw the 
shade down to it. Now, holding the test-tube a little way 
from this background, lift the shade forward, enough to 
allow the rays of light to pass through the tube without 
shining into your eyes. In such a light, and against the dark 
background, very slight opacity becomes visible. 

To detect sugar: fill a clean test-tube to the depth of half 
an inch with Fehling's standard test solution and boil it. If it 
is pure and reliable it will remain clear and of a dark blue 
color. While the clear solution is hot, add the urine, a few 
drops at a time. Sugar will cause a deep yellow or orange 
colored precipitate before the amount of urine added equals 
Hie quantity of test solution employed. If there is no change, 
once more heat to boiling and stand it one side. When cool, 
if there is no change sugar may be considered absent, Squibb's 
Fehling's Test Solution is reliable and can be obtained through 
any druggist. 

When the specific gravity is above or below normal, or 
albumen or sugar are present in a very small quantit} r , it will 
be well to collect the total secretion of 24 hours and examine 
a sample of this mixed urine. 



TABLE EXHIBITING 



THE 



Healthful Average Relation between 
Height and Weight. 









Limit. 


J{T7TnUT 


WEIGHT. 












UNDER. 


1 

OVER. 


5^. 


i in. 


3 20 lbs. 


96 lbs. 


144 lbs. 


5 ft. 


2 in. 


125 lbs. 


100 lbs. 


150 lbs. 


5 ft. 


3 in - 


130 lbs. 


104 lbs. 


156 lbs. 


5 ft- 


4 in. 


135 lbs. 


108 lbs. 


162 lbs. 


5 ft. 


5 m - 


140 lbs. 


112 lbs. 


168 lbs. 


5 ft 


6 in. 


143 lbs. 


114 lbs. 


172 lbs. 


5 >. 


7 in. 


145 lbs. 


116 lbs. 


174 lbs. 


5 ft. 


8 in. 


148 lbs. 


1 19 lbs. 


177 lbs. 


5 ft. 


9 in. 


155 lbs. 


124 lbs. 


186 lbs. 


5 ft. 


io in. 


160 lbs. 


r28 lbs. 


192 lbs. 


5 ft. 


1 1 in. 


165 lbs. 


132 lbs. 


198 lbs. 


6 ft. 




170 lbs. 


136 lbs. 


204 lbs. 



With the Compliments of 



|,lte | ; onneriicut Jjutimt jjfft Insurance ifompng 




THE 



MEDICAL ADVISEE 



IN 



LIFE ASSURANCE 



BY 



EDWARD HENRY SIEVEKING, M.D., 

FELLOW OF THE ROYAL COLLEGE OF PHYSICIANS, 

PHYSICIAN TO ST. MARY'S AND THE LOCK HOSPITALS, PHYSICIAN 

EXTRAORDINARY TO THE QUEEN, PHYSICIAN IN ORDINARY 

TO THE PRINCE OF WALES, ETC. 



SECOND EDITION. 



HAETFOED, CONN 
N. P. FLETCHER & CO 

1886 



Q 



qL> 



6^ 









i-.r*. 



PEEFACE TO SECOND EDITION. 



The object of this small volume is to offer to the 
reader information which, if to be found at all in 
ordinary works of medicine, is so scattered as not to 
be readily available ; while some of its contents are 
suggestions derived from the experience of the 
author, or placed at his disposal by personal friends 
who have been engaged in the study of questions 
connected with life insurance. Being intended to 
serve as a handy book and to be essentially of a 
practical character, it would have been out of place 
to have attempted to embrace a full disquisition of 
the numerous interesting topics to which it adverts. 
When fuller information on any purely medical 
question is desired, recourse to standard works will 
be necessary ; but it is hoped that no topic has been 
omitted to which the medical adviser's attention 
should be specially directed in connection with life 
insurance. 



4 PREFACE. 

The author wishes to record his obligations to 
the numerous friends who have most readily re- 
sponded to his request to be favoured with their 
views on the subjects discussed. Throughout the 
work, he hopes that he has duly quoted the authori- 
ties from whom he has obtained information, whether 
previously published or not, as a convenience to the 
reader for further reference, or as an act of justice to 
his friendly adviser. He trusts that the present 
edition, though not materially enlarged, may be 
found more useful than its predecessor, and especi- 
ally that the index to this volume may enable the 
practitioner more readily to find what he is in 
search of. 

It is to be feared that the author has not found 
materials to meet one desideratum to which he 
alluded in his preface to the first edition ; namely, 
that of rendering the decisions to be arrived at, in 
connection with the questions involved in the ex- 
pectation of life of an individual, more precise than 
they were a few years ago. He professes to have 
no actuarial knowledge, and it is not to be doubted 
that a talent for calculation would in many cases 
be an aid to the medical adviser in life insurance, 
which, with his special professional knowledge, would 
materially assist him in solving certain questions, 



PREFACE. 5 

and not leave him entirely at the mercy of the pro- 
fessed actuary. It is not improbable that in the 
course of time the increasing importance and spread 
of life insurance may become- a special branch of 
study for those who devote their attention to the 
topics embraced under the new term of State Medi- 
cine. We may then hope for more complete agree- 
ment on the main topics concerning the medical 
adviser in life insurance, than now prevails ; and 
considering how closely the welfare of the commu- 
nity is affected in the matter, increased certainty 
and security to one party in the transaction must 
equally benefit the other. 

If this little book in any way promotes so desir- 
able a consummation, its author will consider his 
labour amply rewarded. To the reader who finds it 
tedious, it would say, in the words of Martial * : — 

Si nimius videor, seraque coronide longus 
Esse liber; legito pauca, libellus ero. 

Terque quaterque mihi finitur carmine parvo 
Pagina, f ac tibi me quam cupis esse brevem. 

E. H. S. 

Manchester Square, 
March, 1882. 

* Liber ad lectorem, Epigr. lib. x. 1. 



CONTENTS. 



CHAPTER I. 

Page 
Introduction . . . . .7 



CHAPTER II. 

The Normal Man . . • . .25 

CHAPTER III. 

The Duties op the Medical Officer . . .50 

CHAPTER IV. 

Hereditary Influences . . . .75 

CHAPTER V. 

The History of the Individual . « .99 

CHAPTER VI. 

The Insuree's Liability to Disease . . . 126 



Till CONTENTS. 

CHAPTER VII. 

Page 

The Insuree's Liability to Disease {continued) . 154 

CHAPTER VII. 

The Medico-Legal Aspects of Life Insurance . 170 

APPENDIX ...... 188 



CHAPTER I. 

INTRODUCTION. 

Among the features that may be regarded as charac- 
teristic of modern Christian society, Life Insurance 
stands prominently forward as peculiarly unselfish. 
Its main object, provision for those whom death 
deprives of their bread-winner and protector, en- 
tails self-denial and forethought on the part of the 
individual who takes out a policy, and may . thus 
become indirectly a boon to himself, by compelling 
thrift, and keeping alive the best feelings of our 
common humanity. The more the principles of 
I Life Insurance are understood, the more certain are/ 
* they to be appreciated and acted upon; and while 
they give to society a guarantee for the uprightness 
and honesty of the individual, he in return assists 
in rendering more firm and stable the very ground- 
work of the republic. That the subject is one de- 
serving the attention of Governments has been 
proved by modern enactments, though it does not 
appear, from a return that lies before me, that the 
portion of the public for whom Post Office Insurances 
were specially intended, appreciates this offer of the 



8 INTRODUCTION. 

highest authorities.* Every insurer must desire 
that Government surveillance should be exercised 
closely over all private insurance companies, so as 
to give him and his heirs greater security that his 
confidence is well placed. It is simply impossible 
for any one but a professed actuary to analyse and 
thordhghly to understand the position of any given 
company ; and, considering the helplessness of the 
individual insurer, and the misery that has, .within 
the present generation, been entailed on thousands, 
by mismanaged companies, it is but reasonable to 
desire that the insurer should have a better guar- 
antee for his laudable investment in any private 
company, than that offered by an array of figures 
which he cannot master, and which may prove more 
or less fallacious. 

The relative number of inhabitants of (Jifferent 
localities who have taken out policies of life insur- 
ance may not inappropriately be regarded as an 
index of the prosperity of the communities they 
belong to, for they afford direct evidence of the 
existence of those qualities, thrift, forethought and 
consideration for others, upon which our social 
comfort and happiness chiefly depend. Those qual- 
ities do not necessarily bear a direct ratio to the 
amount of ratable property possessed by these dif- 



*The return referred to 


gives the following 


statistics of the Post Office 


Scheme 


of Life Assurance 








Year. 


Number of 


Amount of 


Year. 


Number of 


Amount of 


Policies. 


Insurances. 


Policies. 


Insurance*. 


1865 


547 


40.647 


1873 


396 


30,073 


ism 


612 


47.261 


1874 


278 


21.622 


1867 


364 


26,988 


1875 


370 


32 022 


1868 


350 


26.781 


1876 


270 


22.875 


1869 


422 


32,670 


1877 


393 


33.444 


1870 


385 


31,254 


1878 


229 


19 608 


1871 


358 


27,695 


1879 


226 


18.870 


1872 


757 


55,982 


1880 


258 


20,378 



INTRODUCTION. 9 

ferent communities, but they form the essential basis 
of Christian society. 

But Life Insurance, like all human enterprises, 
requires to be carried on with care and caution. 
An abstract good may be capable of abuse, and so 
unfortunately life insurance has occasionally been 
turned to a bad account. Direct fraud has crept 
in, of which instructive examples may be found in 
the literature of the subject;* but carelessness and 
a neglect of rules, that must guide all commercial 
transactions, have had more to do with the failure 
of insurance enterprises than attempts at deception, 
which are guarded against with comparative facility. 
Life insurance is essentially a commercial contract 
between two parties ; the basis of which is, on the 
one hand, the truthful representation of certain data 
on the part of the insuree, and the undertaking on 
the part of the insurer to pay a covenanted sum of 
money, provided the former has duly fulfilled his 
part of the agreement, on the occurrence of certain 
contingencies. Now all insurance tables are cal- 
culated so as to allow a margin of profit to the 
companies, provided that the mortality does not 
exceed a certain ratio. An insurance company 
cannot conduct a safe business unless it is able to 
restrict its mortality within the rate provided, and 
to defray its expenses out of this margin allowed 

* The reader is specially referred to Annals, Anecdotes, 
and Legends, a Chronicle of Life Insurance, by John Francis: 
London, 1853 ; and The Insurance Guide and Handbook, by 
C. Walford : London, 1867. Second edition. The latter is a 
mine of valuable and trustworthy information, and we shall 
have frequent occasion to quote from it. 



10 INTRODUCTION. 

for that purpose, in the absence of exceptional 
sources of profit. It is therefore in the interest of 
all policyholders, both for their security and profit, 
that the company should use every reasonable pre- 
caution to see that the basis of the contract on the 
part of the insuree is unimpeachable, just as it is 
the interest of the latter to ascertain that the com- 
pany with which he proposes to insure will at any 
time be able to fulfil its share of the contract and 
pay the claim when it falls due. 

The misfortunes which have overtaken some 
companies, especially of late years, have suggested 
the desirability of converting them all into Govern- 
ment property, a process which has not met with 
much support ; but the greater control exercised 
under the Act of 1870 has been hailed with satis- 
faction, although it lias entailed much labour upon 
them, by all well-established and respectable com- 
panies, because it is believed that it will prevent the 
formation of bubble undertakings, and give the pub- 
lic as great a guarantee of good behaviour on behalf 
of those existing, or to exist in future, as can fairly 
be expected. 

The real stability of an insurance company* 

* T ,Ve follow the prevailing custom of employing the terms 
\ insurance and assurance interchangeably, pace Mr. Babbage, 
who defined Assurance as a contract dependent upon the dura- 
tion of life, which must either happen or fail ; Insurance as a 
contract relating to any other uncertain event which may 
partly happen or partly fail ; thus in adjusting the price for 
insurance of houses and ships, regard is always had to the 
chance of salvage arising from partial destruction. — (Walford, 
p. 2.) 



INTRODUCTION. U 

must after all depend upon the manner and char- 
acter of the work done, and it is only in so far 
as to afford the general public an easy means of 
ascertaining that the staff of the companies are hon- 
estly and conscientiously doing the work intrusted 
to them, that Government control is either wise or 
desirable. The whole science of insurance has been 
developed by individual effort, and it would be in- 
deed strange if pecuniary interests, involving nearly 
one hundred million sterling,* and second only in 
their magnitude to the railway interests of the 

* The reader may be interested in the following statistics 
regarding English life insurance business. There were at the 
end of 1871, 106 returns filed to the Board of Trade (three 
foreign institutions being omitted and two incomplete returns) 
with the following results : — 

Income. 

Total premiums £9,743,600 5 0J 

Consideration for Annuities granted . 254,133 1 6f 

Interest and Dividend .... 4,040,175 3 8£ 

Miscellaneous Receipts .... 115,511 1 1 

£14,153,419 11 4f 



Disbursements. 

Claims . . . . . . . £8,200,993 1 2J 

Surrendered Cash Bonuses and returned 

Premiums 1,063,087 6 8J 

Annuities 386,867 5 

Expenses (including Dividends to Share- 
holders) . 1,870,392 4 

Miscellaneous ..... 106,771 17 6 



<f 



£11,628,111 10 5| 

The Assets amounting in the aggregate 

to £92,332,222 14 3^ 



12 INTRODUCTION. 

country, interests that have enjoyed no Government 
patronage during their minority, should now, when 
they have attained the stature of vigorous manhood, 
require to be put under a nurse's care like the 
rickety bantling of sickly parents. 

The seed of the plant that has grown to such 
dimensions was sown in very modern times ; in fact 
no data upon which any plan of the kind could 
have been formed existed, until that national self- 
knowledge, which depends upon vital and mortuary 
statistics, had been cultivated. Parish registers were 
not kept in England till 1538 ; but it was not till 
nearly two centuries later that they were rendered 
available for calculations on the value and duration 
of life by the addition of the ages of the dead. 
" The earliest movement ' in economical arithmetic, 
and the closest approximation to the data on which 
life assurance is founded," was made by John 
Graunt in the beginning of the seventeenth century, 
in his work entitled, " Natural and Political Obser- 
vations on the Bills of Mortality." Mr. W afford, 
who gives a detailed history of the growth of life 
insurance, tells us that many of Graunt's observa^ 
tions are as curious for their accuracy as for their 
originality. As a specimen of the curious sugges- 
tions which he makes, which may be of use to mod- 
ern political economists, he advised, when the entire 
population of London was about 384,000, th 
means should be taken to check the growth of the 
town, the first point to attend to being, to ascertain 
whether the city of London had " grown big enough." 

It is unnecessary for our purpose to dwell on the 



4- 



INTRODUCTION. 13 

details of the development of life insurance business. 
Suffice it to say that the first actual insurance com- 
pany was established in 1714 ; the Union Assurance 
Society, the London Assurance Corporation, and the 
Royal Exchange Assurance Corporation, followed, in 
1720; the Equitable was founded in 1762; the 
Pelican in 1797. At the present moment the In- 
surance Directory gives the names of 152 companies 
transacting life insurance business, showing the 
enormous extension which this branch of providen- 
tial commerce has taken. Whether it be desirable 
that a larger number of companies should be called 
into existence is a moot point. There are now a 
sufficient number to insure healthy competition ; and 
as at present only a small proportion of the entire 
community are insured, both the security of the 
existing companies and the advantage of the insurees 
would be probably best consulted by the latter rally- 
ing round the old flags, rather than by setting up 
new standards, and involving themselves in all the 
trouble, risk, and expense, attending the creation of 
new companies. Fire insurance dates a little further 
back than life insurance. The " Hand in Hand," 
which, at a later period, also charged itself with life 
business, took its origin at the end of the seventeenth 
century, having been founded in the year 1696, under 
the designation of u The Amicable Contribution," 
which it soon after changed for that of the well- 
known association still transacting insurance busi- 
ness under both forms in Blackfriars.* Grateful as we 

*No history of English men and manners would be com- 
plete without a delineation of the phases through which 



14 INTRODUCTION. 

must feel to the enterprising men who first promoted 
honest life insurance business, we imply no censure 
when we say that, as a matter of fact, they were 
groping in the dark, as they could possess no definite 
principle to guide them, until it was possible to 
establish a firm basis by the preparation of reliable 
mortality tables. Their rates * were extravagantly 

insurance business has passed. In the early part of the last 
century John Bull rode this particular hobby until he ap- 
peared to have lost his wits. Fortunately the disease did not. 
prove incurable ; and, after wandering about in a state of 
maniacal aberration for a time, the patient recovered without 
permanent damage to his constitutional vigour. Insurances 
against thieves, housebreakers, and highwaymen, for making 
pasteboard, for making boards out of sawdust, against lying, 
against death from drinking Geneva, against divorces, for the 
preservation of female chastity, were some of the many pecu- 
liar objects for which companies were established. But fire 
and life bore the palm over all competitors; and their advo- 
cates appear to have shown much pertinacity of purpose, to 
the discomfiture of some quiet people. The following lines, 
quoted by Walford from the Neio Monthly Magazine of a later 
date, illustrate this phase, and perhaps also give the correct 
clue to the original meaning of the terms which Babbage has 
otherwise defined : — 

" By fire and life insurers next 

I'm intercepted, pester'd, vex'd, 
Almost beyond endurance ; 

And though the schemes appear unsound, 

Their advocates are seldom found 
Deficient in assurance." 
*The early offices charged enormous premiums, from not 
possessing reliable data for calculation. The premium to 
assure £100 for one year, on the life of any age between 12 
and 45, was as much as £5 ; whereas the assurance for the 
whole life on the same amount now ranges, according to age, 
from £1 : 8s, to £3 : 12s. 



INTRODUCTION. 15 

high, a fault that might even now be considered as 
leaning to virtue's side, since it added to the security 
of the policyholders, by increasing the assets of the 
companies. To a Unitarian preacher, Dr. Price, 
belongs the honour of having elaborated the first 
English mortality tables, which, from his having 
employed the registers of the births and deaths of 
the town of Northampton for his calculations, have 
received the name, and are still known as, the 
Northampton Mortality Tables. They were pub- 
lished in 1780, and were especially constructed for 
the use of the old Equitable Society. Dr. Halley 
had, at an earlier date, from the mortality records 
of the town of Breslau, drawn up tables giving the 
probabilities of life at every age ; but, from being 
buried in the Philosophical Transactions (1693), 
they bDre no fruit ; and it was reserved to a recent 
date to disinter them, and to accord to their author 
the distinguished merit that belongs to him. Nearly 
forty years elapsed from the appearance of Dr. 
Price's tables, before the Carlisle Tables of Mortality 
were constructed, by Mr. Milne, from observations 
furnished by Dr. Heysham upon the registers of 
Carlisle. There is sufficient agreement in the results 
yielded by Mr. Milne, and Dr. Price's calculations 
to establish their general trustworthiness ; but, dur- 
ing the interval that elapsed between their publica- 
tion, actuarial science had received ampler develop- 
ment ; and the greater precision and lower mortality 
demonstrated by Mr. Milne justly established the pre- 
eminence of the Carlisle Tables, from the date of 
their publication, in 1816. They continue to form 



16 INTRODUCTION. 

the basis upon which premiums of insurance are 
calculated at the present day. 

The main object of all insurance tables is to de- 
monstrate the average expectation of life, as deduc- 
ible from the mortuary registers of the country for 
the entire population. No one has probably done 
more during the present generation to advance our 
knowledge in this branch of statistical science than 
Dr. Farr, of the Registrar-General's office, aided, as 
he has been, by active workers distributed all over 
the country. Nor have their labours been confined to 
determining the general expectation of life at differ- 
ent ages of the members of the community at large, 
but Dr. Farr, Mr. t Willich, Dr. Guy, Dr. Taylor, Mr. 
Neison, Mr. Scratchley, and many others, have 
worked out the problems of the duration of life in 
separate, classes and trades with a minuteness that 
leaves nothing to be desired. We shall take a 
future opportunity of availing ourselves of the prac- 
tical results they have attained in connection with 
various questions of detail ; but it is ever to be 
borne in mind that, nowever valuable and true 
general averages are, they cannot be held as estab- 
lishing the expectation of the individual, in whom 
many contingencies have to be considered before we 
determine the exact position he occupies towards 
the general average. It is for the purpose of ascer- 
taining this position, and estimating the bearing of 
the accidents of hereditary influence, personal con- 
stitution, of trade and occupation, and of previous 
acquired taints or morbid influences, than the phy- 
sician, possessing special qualifications for analysing 



INTRODUCTION. 17 

these various elements, must be called in to assist 
the actuary. While the latter deals with large num- 
bers and averages, the former is more trained to 
observe individuals, and to watch exceptional cases ; 
the objects of life insurance will be in good case 
where the two understand one another, and seek 
heartily to co-operate to the same end. This is well 
illustrated by the remark of Mr. Babbage, when he 
says that " nothing is more uncertain than the dura- 
tion of life when the maxim is applied to the indi- 
vidual ; but there are few things less subject to 
fluctuation than the duration of human life in a 
multitude of individuals." As the question of- the 
expectation of life underlies all insurance calcula- 
tions, and affects largely the estimate of the individ- 
ual insuree by the medical officer, we give the follow- 
ing tables here, in which the expectation of life or 
the period an individual may expect to live, accord- 
ing to the observations made in England, on the 
Contine-nt of Europe, and in the United States cf 
America, is shown :-*- 



18 



INTRODUCTION. 



Table I. — Showing the Expectation of Life, or the period an 
individual of a given age may be expected to live, accord- 
ing to the following Tables of Mortality, deduced from 
Observations made in England.* 



Com- 
pleted 
Age. 


Carlisle. 


! North- 
ampton. 


Seventeen 

Life Offices. 

1843. 


Government 
Annuitants. 


Com- 
pleted 
Age. 










Males. 


Females. 







38.72 


25.18 




50.16 


55.51 





1 


44 68 


32 74 




50.13 


55.59 


1 


5 


51 25 


40.84 




48.93 


. 54 23 


5 


10 


48. 82 


39.78 




45.57 


5105 


10 


13 


46 51 


37.83 


.... 


43 31 


48.70 


13 


15 


45.00 


36.51 




41 76 


47.19 


15 


17 


43.57 


35 20 




40.29 


45.86 


17 


20 


41.46 


33.43 


41.49 


38.39 


43.99 


20 


23 


39 31 


31 88 


39.39 


36.87 


42.09 


23 


25 


37.86 


30.85 


37.98 


35.90 


4<».81 


25 


27 


36 41 


29.82 


36.56 


34.86 


39.52 


27 


30 


34 34 


28.27 


34.43 


33 17 


37.57 


30 


33 


32.3 • 


26 72 


32.30 


31.40 


35.61 


33 


35 


31.00 


25.68 


30 87 


30.17 


34.3! 


85 


37 


29.64 


24 64 


29.44 


28 91 


33 04 


37 


40 


27.61 


23 08 


2728 


27.02 


31.12 


40 


43 


25.71 


21.54 


25.12 


25 08 


29.14 


43 


45 


21.46 


20.52 


23.69 


23.75 


27.81 


45 


47 


23.17 


19 51 


22.27 


22 38 


26.44 


47 


49 


2181 


18.49 


20.87 


20.98 


25.06 


49 


50 


21.11 


17.99 


20.18 


20.30 


24.35 


50 


51 


20.89 


17.50 


19.50 


19.62 


23.65 


51 


53 


18.97 


16.54 


18.16 


18.34 


22.22 


53 


55 


17 58 


15.58 


16 86 


17 15 


20.79 


55 


57 


16.21 


14 63 


15.59 


16.02 


19.38 


57 


59 


14.92 


13.68 


14 37 


1493 


18.00 


59 


60 


14.34 


13.21 


13.77 


14.39 


17.35 


60 


61 


13 82 


12.75 


13.18 


13 84 


16 64 


61 


63 


12.81 


11.81 


12.05 


12.72 


15.30 


63 


65 


11 79 


10.88 


10.97 


11.63 


14.00 


65 


67 


10.75 


9.96 


9.96 


10.61 


12.76 


67 


70 


9.18 


8.60 


8 54 


9 22 


10.99 


70 


73 


7.72 


7.33 


7 26 


7.96 


9.41 


73 


75 


7.01 


6 54 


6 48 


7.12 


8.46 


75 


77 


6.40 


5.83 


5.76 


6 23 


7.58 


77 


80 


5.51 


4.75 


4 78 


4.94 


6.50 


80 


83 


4 6') 


3 80 




3.82 


5.57 


83 


85 


4.12 


3.37 




3.12 


4.84 


85 


87 


3.71 


3 01 




2.53 


4.03' 


87 


90 


3.28 


2.41 




1.95 


2 83 


90 



* Extracted, with slight omissions, from Popular Tables, etc., by C. M. 
Wiilich, edited by Montague Marriott : London. 1857, p. 76. 



INTRODUCTION. 



19 



Table II.— Showing the Expectation of Life, or the Period 
an Individual of a given age may expect to live, according 
to the following Tables of Mortality, deduced from Obser- 
vations made on the Continent of Europe.* 





Saveden 




France. 


Holland. 








Com- 
















Bran- 


Com- 


pleted 
Ace 




Fe- 


General 


General 


State 


State 


Breslau. 


denburg. 


pleted 

A op 


xx s c. 


Males. 




Popu- 


Popu- 


Annui- 


Annui- 


^ 




*?fi c ' 






males. 


lation. 


lation. 


tants. 


tants. 











33.19 


35.70 


34.42 


28.76 


34.89 


34.47 


27.45 


30.68 


O 1 


1 


41.96 


44.00 


42.96 


36.35 


45.67 


4177 


33 43 


37.60 


1 


5 


45.62 


48 00 


46.80 


43.40 


48.35 


44.45 


41.20 


42.94 


5 


10 


43.95 


46.26 


45.07 


40.80 


4K.92 


42.71 


40 40 


42.14 


10 


13 


42.00 


44 26 


43.11 


38.74 


45.08 


40.90 


3£.68 


40.05 


13 


15 


40.f6 


42.77 


41.64 


37.40 


43 66 


39.55 


37.40 


38.64 


15 


17 


39.10 


41.30 


40.18 


36.11 


42 25 


38.19 


36 11 


37.22 


17 


20 


36 P6 


39.15 


3- 03 


31.26 


40 29 


36.31 


34.15 


35.07 


20 


23 


34.94 


37.01 


35.96 ' 


32.48 


38.43 


34.41 


32.22 


33.10 


23 


25 


33.64 


35 58 


34 59 


31.33 


37 21 


33.28 


30.88 


31.76 


25 


27 


32.33 


34.18 


33.23 


30.20 


36 02 


32.36 


29.64 


30.55 


27 


30 


30.33 


32 17 


31 23 


28.52 


34.18 


30.93 


27.81 


28.70 


30 


33 


28.40 


30 27 


29.30 


26 84 


32.26 


29.49 


26.05 


26. >3 


33 


35 


27.09 


29.03 


28.03 


25.72 


S\hb 


2S.36 


24 92 


25 56 


35 


37 


25.77 


27.69 


26.70 


24.59 


29.6:2 


27.22 


23.83 


21.41 


37 


40 


23.75 


25.63 


24.66 


22.89 


27 54 


2'). 50 


22.19 


22.65 


40 


43 


21.89 


23 78 


22.80 


21.18 


25.42 


23 62 


20.57 


20 86 


43 


45 


2<).71 


22 57 


21.61 


20.05 


24.02 


22.34 


19.56 


19.65 


45 


47 


19.69 


21.28 


20.37 


1S.91 


22.61 


21 13 


1854 


18.43 


47 


49 


18.31 


19.23 


19.'. 8 


17.79 


21.21 


19.99 


17 53 


17.18 


49 


50 


17.72 


19.26 


18.46 


17 23 


20.51 


19.41 


17 07 


16.55 


50 


51 


17.18 


18.62 


17.87 


16.67 


19.83 


18.87 


16.61 


15 96 


51 


53 


16.09 


17.39 


16.70 


15.58 


1845 


17.82 


15 71 


14.78 


53 


55 


14.99 


16.16 


15.54 


14.51 


17.15 


16.73 


14.77 


13.68 


55 


57 


13.87 


1490 


14 36 


U.46 


15.92 


15.66 


13 78 


12.68 


57 


59 


12.79 


13.67 


13.20 


12.45 


14.70 


14.62 


12.80 


11.73 


59 


60 


12.25 


13.08 


12.63 


11 95 


14.15 


14.17 


12.30 


11.28 


60 


61 


11.72 


12.54 


12.1Q 


11.47 


13 59 


13.58 


11.81 


10.84 


61 


63 


10.74 


11.51 


11.09 


10.53 


12.52 


12.54 


10.83 


9.98 


63 


65 


9.78 


10.49 


10.10 


9.03 


11.43 


11.56 


9.8; 


9 15 


65 


67 


8.84 


9.17 


9.12 


8.77 


10.37 


10.59 


8.89 


8.3S 


67 


70 


7.60 


7.92 


7.72 


7.58 


879 


9 15 


7.45 


7.39 


70 


73 


6.53 


6.63 


6 53 


6 51 


7.29 


7.74 


6.25 


6.52 


<3 


75 


5.89 


6.03 


591 


516 


6 44 


6.82 


5.51 


6.17 


75 


77 


5.26 


5.43 


529 


5.29 


5.71 


6.02 


4.84 


5.76 


77 


80 


4.27 


4.46 


4.28 


4.60 


4.73 


5.06 


4.08 


5.06 


80 


£3 


3.45 


3.59 


3 57 


4.19 


3.86 


4.09 


3.19 


4.55 


83 


85 


3.16 


3 40 


3.23 


4 16 


3.33 


3.38 


3.37 


4 19 


85 


87 


2.88 


3.23 


2.92 


4.28 


2.72 


2.84 


1.62 


3.61 


87 


90 


2.02 


2.55 


2.05 


3.86 


177 


2.47 


0.50 


2 50 


90 



* Extracted, with slight omissions, from Popular Tables, etc., by C. M. 
Willich. Edited by Montague Marriott : London, 1857, p. 76. 



20 



INTRODUCTION. 



Table III. — Rates of Mortality and Expectation of Life in 
the United States of America.* 



Age. 


Number 


Number 


Expectation 


Living. 


Dying. 


of Lite. 


10 


100,000 


749 


48.72 


13 


97,762 


740 


46.82 


15 


96,28S 


735 


45.50 


17 


94 818 


729 


44.19 


20 


92,637 


723 


42.20 


23 


90,471 


720 


40,17 


25 


89,"32 


718 


38.81 


27 


87,596 


718 


37.43 


30 


85,411 


' 720 


35.33 


33 


82,277 


726 


33.21 


35 


81,822 


732 


31.78 


37 


80,353 


742 


30.35 


40 


78,106 


765 


28.18 


43 


75,782 


797 


25.99 


45 


74,173 


828 


24.54 


47 


72,497 


870 


33.08 


49 


70,731 


927 


21.63 


50 


69,804 


962 


20.91 


51 


68,842 


1,001 


20.20 


53 


66,797 


1,091 


18.79 


55 


64,563 


1,199 


17.40 


57 


62,104 


1,325 


16.05 


59 


59,385 


1,468 


14.74 


60 


57.917 


1,546 


14.09 


61 


56,371 


1.628 


13.47 


63 


53,030 


1,800 


12.26 


65 


49,341 


1,980 


11.10 


67 


45,291 


2,158 


10.00 


70 


38,569 


2,391 


8.48 


73 


31,243 


2,505 


710 


75 


26,237 


2,476 


6.28 


77 


21,330 


2,369 


5.48 


80 


14,474 


2,091 


4.38 


83 


8,603 


1,648 


3.39 


85 


5,485 


1,292 


2.77 


87 


3,079 


933 


2.19 


90 


847 


385 


1.42 



* Reduced from Medical Examinations for Life Insurance by J. A. Allen, 
M.D., New York: 1872, p. 157. 



INTRODUCTION. 21 

These tables offer much food for reflection and 
speculation, which this is not the place to enter 
upon ; but the reader cannot fail to be struck with 
the more favorable prospects of English as com- 
pared with continental lives, if we take the standard 
of the Carlisle tables, which appears to be confirmed 
by the experience of the life offices. During certain 
periods the expectation of life in the United States 
appears higher than it is in England, which would 
lead one to inquire whether the race of life is less 
exhausting on the western than on the eastern shores 
of the Atlantic ; but as the difference is not uniform 
for all ages, Ave are disposed to think there may be 
a fallacy hidden in the figures. 

For a long time it appeared as if an antagonism 
existed between the medical profession and insurance 
companies^ which was due to the fact that the com- 
panies expected the medical attendants of the in- 
surees to communicate to them the medical history 
of their patients without the customary honorarium. 
This could only be regarded as unreasonable, as, for 
their own greater security, the companies asked for 
information from medical men, which was to enable 
them to judge of the eligibility of a particular life. 
All difficulties of this kind are now removed, and 
as the information is given with the consent of the 
candidate for insurance, no breach of confidence can 
be imputed. It is now universally admitted by all 
parties interested, that the medical element con- 
stitutes an important item in the consideration of a 
proposal for life insurance ; and that although the 
regular medical adviser of the company is 1 able, by 



22 INTRODUCTION. 

inquiry and observation, to elicit many points that 
determine the issue, much may elude his vigilance, 
owing to the necessary limits of time and space, and 
also from the reticence, wilful or accidental, which 
many people exercise on matters of health. For 
this reason it is deemed essential by some of the 
best offices to obtain particulars as to previous 
illnesses, hereditary data, and habits, from the gen- 
tleman who has been regarded as the applicant's 
professional adviser. 

The object of the following chapters is to point 
out those features in the constitution, sanitary con- 
dition, family predisposition, and mode of life, of 
applicants for insurance, to which medical men have 
to pay special attention. To those who doubt the 
value of information to the managers of insurance 
companies obtainable by careful medical examina- 
tions, we would address the remarks made by Sir 
Robert Christison in 1853. * By comparing the 
mortality among the insured in the Standard Life 
Office with the mortality from similar causes occur- 
ring in the population at large, the author arrives 
at the conclusion that an assurance company may 
expect to be relieved of a considerable number of 
casualties, which must affect its operations under a 
looser procedure, and he continues : — " If a collec- 
tion of select lives be no better than the average, 
a collection of inferior lives cannot be worse ; con- 
sequently a believer in the inutility of choosing 

* An Investigation of the Deaths in the Standard Assurance Company, by 
Robert Christison, M.D., in Edinburgh Monthly Journal, August, 1853. 



INTRODUCTION. 23 

good lives must be prepared to deal with the 
assurance of none but picked bad ones ; but a 
scrutiny of the last quinquennium of the Standard 
Company supplies positive evidence of the positive 
advantage of a reasonable amount of care in accept- 
ing proposals." * 

The common opinion of all who have had much 
similar experience confirms the justice of the dis- 
tinguished professor's statement; but for the benefit 
of those who do not enjoy the opportunities of per- 
sonal observation, we may quote an illustration given 

* The following remarks by a distinguished actuary on this question 
deserve the attention of every friend and promoter of life insurance: — Mr. 
Griffith Davies (on Annuities) says: "That a very considerable advantage 
accrues to an insurance office by the rejection of bad lives is too evident to 
be denied; for without this caution there is reason to suspect that assured 
lives would be worse than the average, as their acceptance could not fail to 
induce persons of weak constitution to have recourse to life assurance for 
the benefit of their survivors; while those of robust health might think it 
more to their advantage to improve their own savings for the advantage of 
their families. But whether the selection from the class of persons com- 
posing the majority of those who have recourse to life assurances renders 
them better than the average is not so evident; as it will appear by the Table 
herein deduced from the experience of the Equitable, that the mortality 
among the members of that institution approximated exceedingly near to 
that which obtained during the same period among the inhabitants of the 
town of Carlisle, shown by Mr. Milne's table, which there is reason to believe, 
with its author, affords a pretty fair index of the contemporaneous mortality 
among the community at large throughout England and Wales. But even 
granting the mortality among the members of the Equitable to have been 
considerably less than the average among the community at large, the present 
competition, and the possibility of fraud attending the practice of employing 
agents and medical examiners in distant parts of the Empire, not only 
increases the expense, but renders it doubtful whether, even with the advan- 
tage of a greater number of country lives, the persons assured by other insti- 
tutions are likely to average an equal longevity." This opinion was expressed 
more than forty years ago. The change which steam has since wrought in 
the social relations would probably have caused the author to modify it some- 
what had he survived to witness the revolution that has taken place in human 
intercourse through railways and steamboats, the introduction of the penny 
postage, and the spread of education. 



24 INTRODUCTION. 

by the late Dr. Brinton. * He examined a number 
of insurances effected without medical examination. 
From three or four pages of these cases he collected 
no less than forty instances of death by pulmonary 
consumption, at periods which averaged eighteen 
weeks from the date of effecting the policy, but often 
did not exceed three, four, or five weeks. The 
average loss to the Society on these forty policies was 
exactly forty times the premiums paid. 

* On the Medical Selection of Lives for Assurance, by W. 
Brinton, M. D., 1856. Second edition. 



CHAPTER II. 

THE NORMAL MAN. 

Were insurances effected upon every member of the 
community indiscriminately, and did every company 
take its due proportionate share, the risk and the result 
could be calculated with absolute certainty, as the dura- 
tion or prospect of life of each member of the commu- 
nity can be accurately determined. But ihe nature of 
our social relations makes it necessary that the lives 
taken by insurance companies should be selected 
lives, and that they should approach as nearly as 
possible to a standard of perfect health. * Although 
in all well-regulated States the statistics referable 
to the entire population are reliable even to minute 
details, the individual is subject to accidents which 
cannot be foreseen or calculated, and therefore, as 
only a limited number of people appreciate the value 

* For details connected with, and in illustration of, this 
train of thought,, the reader will do well to refer to an admir- 
able treatise by Dr. J. G. Fleming, of Glasgow, entitled Medical 
Statistics of Life Assurance. Glasgow, 1862. The work is 
unfortunately out of print, and we have had much difficulty 
in obtaining a copy for reference. In a careful 'analysis of 
the deaths and causes of death occurring in thirty-six years in 
the Scottish Amicable Society, Dr. Fleming places before his 
readers numerous interesting and important conclusions, some 
of which we shall take the opportunity of reproducing in our 
pages. 



26 THE NOKMAL MAN. 

of life insurance, and there are always many who 
would be willing to benefit themselves to the detri- 
ment of the insurance company, it is necessary 
that the latter should be on its guard against in- 
voluntary deception or actual fraud. A company 
that took no precautions as to selecting average 
lives would, as has been repeatedly the case, soon 
find its assets incapable of covering its liabilities. 
And one of the first conditions of successful life 
insurance business is, that there should be no doubt 
as to its being at any time able to fulfil its engage- 
ments towards those who have invested their money 
in premiums with a view to securing for themselves 
or their successors a stipulated benefit. 

It is equally to the interest of the insurer and 
the policyholder that every guarantee should be 
obtained that the latter offers all the conditions of 
good health, which means that he possesses no he- 
reditary taint, and that his organs and functions 
are in a condition to enable him to bear the wear 
and tear of life without unnecessary detriment. He 
should approach as nearly as possible the ideal or 
typical man, the limit of whose age may reasonably 
be assumed to lie somewhere between TO and 80.* 
Practically it is impossible to insure perfect hp^Ich 
in a large number of insurers, though Dr, Fleming 
and others show that in the aggregate their rate of 

* This agrees with the scriptural threescore years and ten, 
but it is to be observed that in Genesis (vi. 3,) the days of 
man are promised to be one hundred and twenty years. 
Flourens and Buffon are both of opinion that the natural 
term of existence is one hundred years. 



THE NORMAL MAN. . 27 

mortality is lower than that occurring among the 
general population. The influences that we are all 
subject to, owing to the hereditary impress we re- 
ceive before birth, the neglect of sanitaiy laws, the 
friction we undergo in our passage through life, the 
labour and anxiety associated with existence, impair 
in the individual, to a great extent, the standard of 
perfect health, which theoretically may be attained. 
For this deviation the tables of insurance premiums 
are calculated to make due allowance ; for if there 
were not a proper margin for the accidents of life, 
no insurance business could be safely conducted, 
and it is, even with that condition, necessary to have 
large averages, in order to secure permanence and 
stability. 

Before proceeding to the consideration of those 
elements which impair the prospect of life and 
diminish the working capabilities of our organism, 
it may be well to devote some space to the examina- 
tion of the conditions which constitute . perfect 
health, and of the means at our disposal to deter- 
mine their existence. It is the departure from these 
conditions that constitutes the real difficulty of the 
medical referees of life insurance associations, who 
are bound to reverse the legal theory that every man 
is innocent until he be proved guilty, and to assume 
that every candidate for insurance is more or less 
unsound until his physical health is conclusively 
established. 

We cannot regard the individual as self-contained. 
From the earliest history of man the influences 
imparted by progenitors to their descendants have 



28 THE N0UMAL MAN. 

been recognized ; and though such influences may 
be neutralised or modified by training and educa- 
tion, they will ever imperatively demand ^a large 
share in the estimate of individual quality and 
character. The Mosaic account of the origin and 
development of the Jewish race has a red line of 
genealogical doctrine running through it, which 
presents features of the greatest interest to the 
student of mankind, while the " Fortes creantur 
fortibus et bonis" of Horace is only one of the 
many instances of a recognition of the same princi- 
ple by profane writers of antiquity, which has re- 
ceived larger and more scientific treatment by philo- 
sophic inquirers of recent times. 

for the purpose of life insurance it is necessary 
to determine the existence and the character of 
hereditary influence from three aspects. The evi- 
dence obtainable may be derived from preceding 
generati ns, from collaterals, and from descendants. 
It has been too much the custom to pay regard only 
to the vital power of progenitors ; but important as 
this point is, we shall find, when discussing special 
morbid taints, that the health of collaterals offers 
very valuable indications as to the health of an 
insuree, which are not afforded or not accessible 
when the former alone is examined. The condition 
of descendants, in the nature of things, does not so 
frequently assist in determining the health of their 
predecessors, because, though theoretically of simi- 
lar import, the age of insurers generally militates 
against this element becoming an item in the cal- 
culation of their vital power. Apart from the 



THE NORMAL MAN. 29 

actual health of the progenitors, physiological con- 
ditions come into play, that frequently determine 
the viability of their offspring, some of which at 
least are readily ascertainable. To these belong the 
relative ages of the parents at the time of the in- 
suree's birth. The question of syphilis necessarily 
plays an important question in connection with mar- 
riage, and every conscientious medical man will 
necessarily exercise great caution in giving his pro- 
fessional consent to the marriage of a person who 
has had syphilis.* Great disparity of age is justly 
regarded as exercising a prejudical influence, even 
though other points arc favourable. Blood relation- 
ship, again, which in this country is not a bar to 
marriage in degrees that physiologically are objec- 
tionable, leads to the production of a sickly offspring, 
which may not at the time of insurance have ex- 
hibited any failure of power, but which nevertheless 
would be less capable of resisting morbid influences, 
to which they must sooner or later be subjected. 
It is this power of resisting disease, the vis insita, 
to which in all cases the medical referee's attention 
requires to be specially directed. The actual mal 
ady or morbid taint is comparatively easy of cktee 
tion, but the gauge that is to test the insuree lies in 
the means of estimating his ability to undergo the 
heat and burden of active life, and to ward off or 
bear with impunity the noxious influences which he 
cannot altogether escape. 

In the increasing intercourse among the nations 
of the world, and the intermarriage between difler- 

* On this and allied subjects, see A Treatise on Syphilis in New-born 
Children, by P. Diday, p. IT, translated by Dr. Whitley for the New Syd. 
Soc, 1849. 



30 THE NORMAL MAN. 

ent races, considerations may be expected to arise, 
which, with the spread of life insurance to the de- 
pendencies of Great Britain, will merit future discus- 
sion. The deterioration of race in various parts of 
the globe has already attracted attention, and it is 
an acknowledged fact that the burgher population of 
Ceylon, descended from the earlier Dutch settlers, 
no longer presents the sturdy characteristics of their 
forefathers. As yet, fortunately, we possess no 
analogous declension in any British community ; but 
the locality of birth, even where the parents are 
healthy, already deserves the attention of the 
medical referee in the examination of English lives. 
Whether, in the course of time,* a change in the 
habits, and the adoption of hygienic measures not 
yet appreciated, may modify the effect of climate, 
remains to be seen ; but for the present it is an 
undoubted fact that the healthy children of healthy 
English parents born in tropical regions, after a few 
years pine away, and unless sent to temperate zones, 

* That such an anticipation is reasonable, is borne out by facts already at 
our disposal; thus it is found that although, according to the sanitary report 
of the Bengal Presidency for 1871, the death of European children in the 
plain of India, amounts to 91"4 per 1,000, the mortality at a school in Rajpoot- 
ana, in existence since 1854, on Mount Aboo, has only been 8 per 1,000. The 
site of the school is 4,500 feet above the level of the sea, and enjoys a mean 
temperature of C9° F. In order to show the contrast between the ordinary 
mortality of English children brought up in England and India respectively, 
we annex the following tabular statement of their death-rates compiled by 
Dr. Fayrcr {Brit. Med. Journ., May 3, 1S7C). 

England. India. 

Under five years . 67'58 . . . KS'IO per 1.C00. 

Five to ten years . 8'80 ... 17*73 ,, 

Ten to fifteen years . 4'98 ... 11 '51 „ 
We experience some doubt as to these numbers being correct, as the mor- 
tality for the children in England is manifestly too low; but Dr. Fayrer's 
authority stands too high to doubt the general results to which the table 
points. 



THE NORMAL MAN. 31 

lose the vigour which is their inheritance. The 
longer their return is delayed, the greater will be, 
cseteris paribus, the impairment of vital power, 
which, apart from actual disease, will tend unfavour- 
ably to modify this susceptibility to disease, and 
to diminish their prospects of longevity. 

As regards temporary residence in various coun- 
tries, it is questionable whether, in the present state 
of social intercourse, and with the improved methods 
of communication and sanitary appliances of all 
kinds, it can be considered as affecting life insurance 
prejudicially. Messrs. Bailey and Day* show, in 
opposition to Dr. Guy, that the members of the 
peerage enjoy a high average duration of life, and 
refriark that the male lives of that class enter the 
army and navy in large numbers, travel extensively, 
and are more exposed to what assurance offices con- 
sider extra risks, than the middle classes. They 
infer that differences of climate have less effect on 
human mortality than differences of occupation and 
position in life, and that, as the offices do not attach 
much importance to the latter, they might relax 
somewhat in their estimate of the former. We 
willingly adopt the corollary without the reason 
assigned, for we hold that offices ought to be more 
particular than they are in considering the influence 
of occupation on the expectation of life. 

Physically, as well as morally, the child is un- 
doubtedly " the father of the man." Everything. 
therefore, that aids in the normal growth of the 

* On the Rate of Mortality amongst the Families of the 
Peerage. — Assurance Magazine, July 1861. 



32 THE NORMAL MAN. 

infant, materially affects its future well-being. Hot- 
house plants, and plants overstimulated by rich 
manure, are the exact prototypes of children reared 
in a manner calculated to anticipate the normal 
periods of development. The laws of nature are not 
difficult to read that bear upon this matter; and 
were it possible to go into the question of early 
training of our applicants for insurance, we should 
doubtless be able to fix, with greater certainty than 
we now possess, their future chances of life. I allude 
more particularly to the feeding of infants,* to the 
prejudicial influence of hand-feeding, adopted for 
various reasons to which it is unnecessary to allude 
here, in lieu of the only physiologically correct food 
for infants, the maternal milk. During the later 
periods of childhood, the employment of artificial 
stimuli of all kinds, physical, emotional, and intel- 
lectual, largely impairs brain-growth, muscle-growth, 
blood-growth, either by a development of one part 
of the organism at the expense of another, or by 
directly stunting the entire process of nutrition. 

We need scarcely dwell longer on the aspects of 
childhood in reference to life insurance at present. 
Although some offices present an attractive feature 
with reference to early insurance, by which the 
premiums are returnable if death occurs before the 
age of 21, this very arrangement renders as close an 

* Those who wish to study the laws governing the nutri- 
tion and development of the child, are particularly referred 
for valuable information to Dr. Edward Smith's elaborate 
work on Health and Disease, as influenced by the Daily, 
Seasonal, and other Cyclical Changes in the Human System * 
London, 1861. 



THE NORMAL MAN. 33 

investigation into the antecedents of the child less 
necessary than it becomes during the periods of life 
after growth is completed, and when applications for 
insurance are most largely made. But when man- 
hood is established, the question of the extent to 
which, within the limits of health, variations of 
structure and function may exist, become of para- 
mount importance ; and it is here that we par- 
ticularly look for a standard of comparison by 
which to determine the departure from the typical 
man, without recognizing a positively morbid con- 
dition. 

The remarks that follow are chiefly the result of 
observations made upon members of that somewhat 
complex race to which the modern Briton* belongs ; 
and as he is not regarded as inferior to any of his 
contemporaries, whatever is true in him may be 
applicable to mankind at large. 

The period of complete manhood is fixed by law 
at 21 ; but physiologically this is certainly not 
universally correct, for although development may 
be regarded as accomplished in every respect at this 
age in the healthy English female, and vertical 
growth may have terminated even in the male, a 
man's vital power cannot be regarded as having 

* This term is used advisedly, because there are observed 
differences between the three chief divisions of the inhabit- 
ants of Great Britain; and if the term Englishman were 
employed here, it might lay the writer open to the imputa- 
tion of wishing to ignore features indicating a physical supe- 
riority of the Scotchman or the Irishman. For the purpose 
in view, such a distinction would be unnecessary. 



34 THE NORMAL MAtf. 

attained its maximum development until about the 
age of 30. * For some years after the youth has 
ceased to grow, in the ordinary sense of the word, 
the dimensions of his chest, the great index of vital 
power, continue to expand, and numerous are the 
instances derived from military experience, showing 
that recruits at the age of 20 are unable to undergo 
the fatigue of active service, that is borne with 
impunity by men of a more mature age. f They 
are literally not as yet well knit together. Several 
important bones are not perfectly consolidated, and 
it may be specially mentioned that the sternum, 
which has to bear so great a strain in laboured re- 
spiration, and is specially taxed by the weight of the 
soldier's knapsack, is not converted into a single 
plate of bone until after the thirtieth year. It is 
not until the sixth quinquennial period of life that 
our leading anatomical authorities find that the fol- 
lowing events, connected with the consolidation of 
the skeleton, take place : — 1. Completion of the ver- 
tebral column ; 2. Completion of the sacrum ; 3. 
Coalescence of the third with the second piece of 

* Quetelet (Sur l'Homme et le Developpement du ses 
Facultes, Paris, 1835) shows that the growth of man cannot 
be regarded as universally complete at the age of 25 ; see his 
Tables of Measurement taken on inhabitants of Bruxelles, vol. 
ii. p. 13. Quetelet also gives tables showing the completion 
of female growth at 20, and the completion of male growth 
at 30. 

t For detailed information upon this point, the reader is 
especially referred to Professor Aitken's work, on the Growth 
of the Recruit : 1862. 



THE NORMAL MAN. 35 

the sternum ; 4. Completion of the ribs ; and 5. Co- 
alescence of the haunch-bones with their crests. 

The average height of an Englishman brought up 
under favourable circumstances is 5 feet 9§ inches, 
which is notably above that of the average Belgian, 
Frenchman, or Italian. The height of the average 
English female appears to be about 5 feet 2 inches. * 
It would be difficult to fix the limits at which height 
and health are incompatible. The downward range 
is certainly larger than the upward range, which 
appears due to the fact that the vital organs, the 
heart, and the chylopoietic viscera, do not keep pace 
in development with the muscular and osseous 
systems of persons exceeding the normal elevation. 
We more frequently meet with people of diminu- 
tive stature, with a perfectly equable development 
of external and internal organs, who, for pur- 
poses of life insurance, would offer every reason- 
able guarantee for their viability, than with men 
and women materially exceeding the average stature, 
in whom some invalidating element in the organs 
of sanguification, circulation, and innervation, may 
not be traced. Ceteris paribus, the small person is 
more easily nourished, and if, at the same time, the 
respiratory function is well carried on, which we 
shall shortly see is one of the most assured signs of 
vigour, he is on the whole better adapted for the 
warfare of life than his overgrown neighbour, to 
whom, possibly, he may look up with envy. 

We will next examine the bearing of the weight 

* Cowell's Factory Reports, quoted by Quetelet, vol. ii. p. 18, 



36 THE NORMAL MAN. 

of the individual upon health. Here we find, nor- 
mally, a progressive increase from birth to the 
decline of life, which must not be regarded as iden- 
tical with development, as we have seen that the 
full growth of the body reaches its acme in the third 
decennium of life. The increase of weight that takes 
place at a later period is due to the accumulation of 
fat under the skin and in the cavities of the body, 
and, as is well known, very commonly assumes 
morbid proportions, which often affect the life insur- 
ance value of the individual. From birth * the male 
sex exceeds the female, both in size as well as 
weight, and this prevails throughout life excepting, 
according to Quetelet, f at the age of 12, when the 
weight of both is the same ; but it appears, accord- 
ing to the same authority, that the female attains 
her maximum of weight at a later period of life 
than the male. 

According to Liharzik, J the normal growth of the 
human body is completed at the end of the 25th 
year. He estimates the mean height of a " growing 
lad " at 18 years at 163 centimetres, or 64*17 inches, 
and that of a man who has completed his normal 
growth at 68*9 inches. 

The average weight of a young Englishman of 
21 is 151 lbs., but the table in ordinary use to 
determine the normal height and weight of appli- 
cants for insurance is given for the age of 30, at 

* Quetelet, vol. ii. pp. 8 and 35, et seqq. t Vol. ii. p. 47. 

{Law of Increase, by F. P. Liharzik, M. D. : 1862. See 
also Aitken's Growth of the Recruit, and Dawson in Statis- 
tical Journal, March 1862. 



THE NORMAL MAN. 



37 



which there is already an increase upon the former 
estimate ; it will also be seen that the average in- 
crease per inch of stature above 5 feet is 5^ lbs., 
although the range of variation at the different 
heights is greater than might have been supposed 
a priori. 



Model Heights an# Weights. 










Age 30. 








The Height being 


The Weight should be 


5 feet 


1 


inch . 


. 8 


stone 4 


lbs. 


5 „ 


2 


tt 




. 9 


)> 





ii 


5 „ 


3 


it 




. 9 


ii 


7 


ii 


2 „ 


4 


ii 




. 9 


ii 


13 


ii 


5 „ 


5 


ii 




. 10 


ii 


2 


ii 


5 „ 


6 


ii 




. . 10 


ii 


5 


ii 


5 „ 


7 


„ 




. 10 


ii 


8 


ii 


5 „ 


8 


ii 




. 11 


ii 


1 


ii 


5 „ 


9 


ii 




. 11 


ii 


8 


ii 


5 „ 


10 


ii 




. 12 


ii 


1 


ii 


5 „ 


11 


ii 




. 12 


ii 


G 


ii 


6 „ 





ii 




. 12 


r 


10 


ii 



Although the standard supplied by this table 
may be regarded as a valuable indication of the 
individual's health, it must not be relied upon alone 
as a test of his suitability _or insurance. Consider- 
able variations occur within limits that do not 
impair the prospect of longevity ; but where they are 
marked, greater care is requisite to determine the 
value of other points that bear upon the viability of 
the person under examination. Such variations de- 
pend upon race, employment, age, habits of life, sex, 
and temperament, which, from the absence of suffi- 



38 THE NORMAL MAN. 

cient data, it would be impossible to formularise, but 
which, nevertheless, are roughly taken into consider- 
ation in estimating the value of a life. We all 
know that a Scotchman does not yield in bodily or 
mental vigour to the Englishman, yet experience 
teaches us that the average weight of the former is 
less than that of the latter.* Dr. James Forbes, 
when Professor of Natural Philosophy in Edinburgh, 
examined 800 students with reference to their phy- 
sical development, distinguishing the natives of 
England, Scotland, and Ireland. He found the law 
established that development in every respect in- 
creases between 14 up to 26 years of age, but that 
the increase became slower as the age advanced. 
Our Scotch friends will be pleased to hear that, 
tested by Regnier's dynamometer, Scotchmen were 
superior to Englishmen in tractile power. This 
being measured by pounds gives for 

Englishmen at the age of 20 to 55, 366 to 384 lbs. 
Scotchmen „ „ 374 ,, 404 „ 

Irishmen „ „ 397 „ 413 „ 

Sedentary occupations, with an ample food-supply, 
tend to increase the weight, f while it is reduced by 
employment involving continued open-air exercise 
and a tax upon the muscular system. An undue 
diminution of weight would be regarded with more 
suspicion early in life, as indicating impaired nutri- 
tion, and taken with any symptom, not by itself 
adequate to raise a doubt, that tended in the same 
direction, might justify rejection. On the other 

* Aitken's Growth of the Recruit, pp. 44 and 71. 

t Dr. Symes Thompson (On Gout in relation to Life Assurance— Medical 
Times and Gazette, 1879) informs us that the experience of the Equity and 
Law Office shows that those rated up for corpulence have proved a very had 
class of lives, needing on an average an extra charge of 25 per cent. 



THE NORMAL MAN. 39 

hand, an abnormal elevation of weight when man- 
hood is established, though compatible with health 
if the occupation and «mode of life be healthy, may 
imply a tendency to fatty degeneration, or to apo- 
plectic affections where the concurrent circumstances 
are not equally favourable. In all these questions 
a certain latitude is unavoidable, and what is tech- 
nically called circumstantial evidence must guide 
the inquirer in arriving at a conclusion. Dr. Pur- 
don, in a recent pamphlet on life insurance, following 
Dr. Brinton,* allows a variation of 20 per cent as 
compatible with health. This may be exceptionally 
true, but, practically, it is found where early deaths 
occur from constitutional disease that a smaller 
variation than this implies ought, at the time of in- 
surance, to have attracted attention and commanded 
an increased rate, although no other indication of 
a hereditary or constitutional taint existed. Our 
own experience leads us more and more to regard 
the .table as a valuable aid in determining the value 
of an applicant's life, and we regard with suspicion 
any material departure from the law it appears to 
involve. 

Any sudden change of weight demands still more 
careful consideration than a habitual departure 
from the normal standard. It may, as in an obese 
person, be the result of an illness that restores a 
healthy state of things, but it is more frequently 
the forerunner of disease ; when it takes the form 
of reduction, we look for some morbid taint that 

* On the Medical Selection of Lives for Assurance, 2d 
edition, 185G. 



40 THE NORMAL MAN. 

induces wasting, as consumption, persistent dys- 
pepsia, syphilis, renal disorders, leucorrhoea, pro- 
found emotional disturbance, and other causes of 
mal-nutrition ; where it runs in the opposite direction, 
the prospect of life may be affected by alcoholism, 
by degeneration of the vessels, leading to cardiac, 
renal, or cerebral mischief, or by some analogous 
impairment of the nutritive powers. 

A very interesting table, showing the relation 
between height and weight, was compiled about 
twenty years ago by Mr. Hutchinson,* based on an 
examination of 3000 males. It is buried in a 
valuable article on respiration, published in a pro- 
fessional volume of Transactions, and is therefore 
not easily accessible. Moreover, as it applies to 
lives varying in age from 15 to 40, it does not 
serve the purposes of life insurance so well as one 
which refers to the age of thirty, when, for all 
practical considerations, development may be said to 
have attained its acme. Still, as Mr. Hutchinson's 
researches have afforded the main basis for establish- 
ing this particular feature in connection with an 
estimate of health, and as his claims as an original 
worker are frequently ignored, we reproduce his 
table here. We premise that the classes whence 
he took his materials were sailors, firemen, metro- 
politan police, Thames police, paupers, artisans, 
labourers, Grenadier Guards, Horse Guards, printers, 
draymen, wrestlers, pugilists, Oxford and Cambridge 
rowers, London watermen, cricketers, pedestrians, 

* On the Capacity of the Lungs and on the Respiratory Functions. — Medico- 
Cliirurgical Transactions, vol. xxix, p. 137. 1C46. 



• 



THE NORMAL MAN. 



41 



and gentlemen ; a list sufficient to justify the belief 
that the results afford a fair average of the popula- 
tion. 





He 






No. 


Gross weight 


Mean weight 




ight. 




of cases. 


in lbs. 


in lbs. 


4 ft. 6 


in. 


to 5 


ft. in. 


26 


2,399 


92-26 


5 


11 


5 


1 


17 


1,964 


115-52 


5 1 


11 


5 


2 


38 


4,476 


124-33 


5 2 


11 


5 


3 


43 


5,497 


127-86 


5 3 


11 


5 


4 


88 


12,145 


138-01 


5 4 


11 


5 


5 


126 


17,537 


139-17 


5 5 


11 


5 


6 


214 


31,016 


144-93 


5 6 


11 


5 


7 


316 


45,598 


144-29 


5 7 


11 


5 


8 


379 


57,822 


152-59 


5 8 


11 


5 


9 


468 


73,835 


157-76 


5 9 


11 


5 


10 


368 


61,238 


166-40 


5 10 


11 


5 


11 


348 


59,460 


170-86 


5 11 


11 


6 





245 


43,475 


• 177-45 


6 6 


11 








326 


71,283 


218-66 


3000 


488,745 


147-86 



According to this table the average adult English- 
man would weigh (say) 148 lbs.; but if we calculate 
the average from the weights given for the heights 
ranging from 5 feet 6 inches to 6 feet, both inclusive, 
we obtain the average of 161*5 lbs., which may be 
regarded as more closely approximate to the truth. 

Of all the points bearing upon the present health 
and the future prospects of an individual, there is 
probably none that exercises a greater influence, and 
more deserves our attention, than his respiratory 
power as indicated by the development of his chest 
and its contents. Here again we are largely in- 
debted to Mr. Hutchinson, whose table of heights 



42 THE NORMAL MAN. 

and weights we have just quoted, but which forms 
only a very subordinate portion of the essay in 
which, with great research and minuteness, he in- 
vestigates the relation between vital power and 
pulmonary capacity. It is fortunate that we possess 
more perfect means of gauging the power of the 
thoracic viscera, than are applicable to any other 
viscera of the body. We cannot only measure the 
external dimensions of the chest and determine the 
physiological movements of its walls, but we are 
able to watch the process carried on within, by the 
stethoscope and by percussion, by the spirometer, 
and by the sphygmometer, with results that amount 
to almost absolute certainty. In the ordinary in- 
quiries necessary for life insurance, it is scarcely 
practicable to bring all these methods of research to 
bear upon every candidate for insurance. But there 
can be no doubt that, were we not afraid of frighten- 
ing the customer, or were time no consideration, a 
more careful application of the various tests of 
pulmonary capacity would prevent many lives from 
being passed as normal, that now become claims at 
an earlier period than the medical examiner and 
his Board of Directors had reason to anticipate. 
Respiration and life may be regarded as synonymous, 
and we find that vital power may be measured by 
the manner in which the functions of respiration are 
carried on. Hence the stress that medical men, 
and even popular opinion, lays upon the value of a 
well-developed chest, which affords an indication of 
what Mr. Hutchinson was the first to term the vital 
capacity of the lungs. In ordinary quiet respiration 



a 



THE NORMAL MAN. 43 

the thorax is neither fully expanded, nor fully 
emptied of the contained air. To measure its entire 
capacity — i.e. to determine the whole amount of air 
which it is capable of taking in and discharging in 
one respiratory act* — it is necessary that a forced 
inspiration and a forced expiration should be made. 
Even after the latter act, a portion of " residual air" 
remains in the lungs, which is entirely independent 
of the will, and always present in the chest. Mr. 
Hutchinson terms the air of ordinary respiration 
breathing air;" that of forced inspiration "comple- 
mental air ;" and that of forced expiration " reserve 
air." The following table shows how widely previous 
observers had differed as to the quantity of air 
belonging to each of these divisions. They regarded 

Residual air, as ranging from 40 to 260 cubic inches. 
Reserve air „ „ 77 170 ,, 

Breathing air „ „ 3 100 „ 

Complemental air „ ,, 119 200 „ 

Vital capacity „ „ 108 300 „ 

These discrepancies were due to Mr. Hutchinson's 
predecessors not having had regard to a variety of 
collateral circumstances which ought to be taken 
into account in estimating the process of respiration. 

* It seems almost superfluous to insist upon the respiratory 
act consisting of inspiration and expiration. But as the 
frequency of respiration is required by most offices to be 
stated in their examination papers of candidates for assurance, 
it has occasionally happened to us to meet with replies of 
medical men, showing that even they treated inspiration and 
expiration as two distinct acts of respiration, which always 
gives a rate that in itself alone would suffice to justify 
rejection. 



44 THE NORMAL MAN. 

These are especially the power of the muscles con- 
cerned in respiration, the circumference of the chest, 
the height and weight of the individual, the pulse, 
the number of respirations, and the age. 

We have already dwelt upon the questions of 
height and weight in assisting the determination of 
the normal conditions of the individual ; we shall 
now see how the indications by these two elements 
receive further support in their relation to the vital 
capacity of the lungs. The greater advance we may 
make in inquiries of this nature, the more perfectly 
is the law of proportion that governs the typical 
man demonstrated ; rendering it equally apparent 
how undue or imperfect development of any one 
organ or function throws the remaining organism 
out of gear, and constitutes a greater or less tendency 
to disease. 

For a description of the methods, and especially 
of the spirometer, an instrument for measuring the 
air expelled during expiration, as well as for many 
details of great interest, we must refer the reader to 
the original paper by Mr. Hutchinson. It will 
suffice for the purpose of the present work to extract 
some of the chief practical results which he has 
attained. 

The mean results of spirometrical measurements 
of the vital capacity of 1923 men, belonging to 
different classes of society, arranged according to 
height, together with their mean weights, are com- 
piled in the following table, from which it will 
appear that there is a definite increase of vital 



THE NORMAL MAN. 45 

capacity closely proportionate to the increase in 
height : 

Mean Vital Capacity of 1923 Men belonging to 
different classes of society. 



Under 


5 


ft. 




135 


cubic in. 


92*26 wei 


glit in lbs. 


5 ft.'O 


in. to 5 ft 


. 1 in. 


175 


ii 


115*52 


ii 


5 „ 1 


ii ii 


5 


ii 


3 » 


177 


ii 


124-33 


ii 


5 „ 2 


ii ii 


5 


ii 


3 -„ 


189 


ii 


127*86 


ii 


5 „ 3 


11 V 


5 


,, 


4 „ 


193 


ii 


138-01 


if 


5 „ 4 


ii V 


5 




5 „ 


201 


ii 


139-17 


51 


5 „ 5 


Ii V 


5 


ii 


6 „ 


214 


ii 


144-93 


11 


5 „ 6 


11 11 


5 


ii 


1 ii 


229 


ii 


144-29 


U 


5 „ 7 


11 V 


5 


ii 


8 „ 


228 


ii 


152-59 


11 


5 „ 8 


M H 


5 


ii 


9 „ 


237 


ii 


157-76 


11 


5 „ 9 


11 11 


5 


11 


10 „ 


246 


ii 


166-40 


11 


5 „10 


11 11 


5 


ii- 


ii „ 


247 


ii 


170-86 


11 


5 „11 


11 11 


5 


ii 


12 „ 


259 


ii 


117-45 


11 


Over six feet 








276 


ii 


218*66 


11 



The mean for all heights being 217 cubic inches.* 

When vital capacity is compared to weight, 
without reference to height, we fail to find the same 
progressive ratio of the respiratory power ; thus the 
mean vital capacity of 147 men weighing 11 stone 
was 225 cubic inches; while that of 32 men of 
1*4 stone only showed an increase of 8 cubic inches ; 
so that, if there is, as we believe, a correlation 
between vitality or vital power and vital capacity, 
the man of lower weight has, caeteris paribus, the 
better prospect of longevity. 

The vital capacity is found to increase from the 
age of 15 to 35, whereas from 35 to 65 it is de- 

* The weights in the above table are the results obtained 
from a different and larger number of men than those 
examined for their vital capacity. 



46 THE NORMAL MAN. 

creased in the progression of 19, 11, and 13 cubic 
inches. It is remarkable, that although there is an 
exact relation between the circumference of the chest 
and weight, with which it increases in the exact 
arithmetic progression of 1 inch, for every 10 lbs., 
Mr. Hutchinson was unable to find any such definite 
relation existing, as might be reasonably inferred, 
between the circumference of the chest and vital 
capacity. This result is so much opposed to the 
teachings of anatomy and vital dynamics, that al- 
though we cannot doubt the correctness of Mr. 
Hutchinson's observations, we think there must be 
some underlying fallacy dependent upon unobserved 
influences, or upon an insufficiency in the number 
of cases examined. Some of the points in his inves- 
tigations have been confirmed in a remarkable manner 
by those of Dr. Balfour,* to whose researches we 
shall have an opportunity of alluding again, when 
we examine the bearing of spirometry upon chest- 
disease in connection with life insurance. 

Very few remarks on the organs and functions of 
the body that we have not yet alluded to will bring 
to a close what we have to say in this chapter on 
the subject of the average man. There are no special 
tests by which we determine the healthy condition 
of the brain, or the abdominal viscera, as bearing 
upon life insurance. The absence of any morbid 
taint, which will form the subject of future chap- 
ters, must be' taken as negative evidence of health, 
which is otherwise indicated by those evidences of 

* Contributions to the Study of Spirometry, by J. G. 
Balfour, M.D.,F.RS — Medico- Chirurgical Transactions, 1860. 



THE NORMAL MAN. 47 

normal development which we have recently dis- 
cussed. 

The decline of life * commences at periods which 
vary with the variations of hereditary and acquired 
vigour of the individual. Any exhausting influences 
that sap the powers of innervation or nutrition in 
youth and manhood will cause a premature senility, 
which, without actual disease, impairs the prospect 
of life of the individual. As a general rule, it is 
found that persons who have borne the battle of life 
well, and have passed the climacteric unscathed, are 
good subjects for insurance. The higher rates are, 
of course, calculated for the probable duration of life, 
but the casualties from unforseen disease are smaller 
than occur during the earlier decennia. Women 
have passed the dangers incidental to their sex, and 
men are no longer exposed to temptations and dan- 
gers which beset them in the heyday of youth and 
early manhood. 

* It has often struck us of late years that it has become 
much more difficult to judge of the age both of ladies and, 
gentlemen than we used to find it. This is doubtless in part 
due to the greater attention to sanitary laws ; but our 
personal knowledge of the arcana of the toilet of many friends 
and patients compels us to believe that the dentist and the 
hairdresser have a great deal to do with the rarer appearance 
in the consulting-room of old people who "look their age." 
It might be a question whether the use of dyes, or, as they 
are euphemistically termed, restorers, washes, tinctures, balms, 
and what not, belongs to the venial deceptions practised in 
society, or whether insurance companies have a right to class 
them under the more opprobrious term of frauds. Perhaps 
we may consider ourselves living in a " Happy Land/ 1 where- 
every " get up " is permissible which bears no allusion to 
political characters. 



48 THE NORMAL MAN. 

When we arrive at the consideration of the death 
of our typical man, it is melancholy to see how far 
in reality we are removed from the attainment of 
the end to which all sanitary science tends, in spite 
of the positive improvements which have demon- 
strably taken place since statistics have given us 
satisfactory data by which to judge of questions 
affecting the health of the population. 

There is no natural termination of life but old 
age. 

Yet we find by the Registrar-General's 14th and 
15th annual reports, that of a total mortality for 
England of 395,396 from all causes in one year, only 
25,996 were reported as having died of old age, or 
6*5 per cent. The mortality in 1871 was 574,879, 
of which 23,038 were attributed to old age, or 5*4 
per cent, a diminution that is more probably due 
to better diagnosis than to a change in the conditions 
of disease.* At any rate, it is sad to find that, 
according to the last report of the Registrar-Gen- 
eral (1881), even this improvement has not been 
maintained, for we are there told that the mortality 
from all causes for males and females in 1879 was 
526,255, of which 29,525 were set down to old age, 
or 5 5 per cent, f 

* See Table of Causes of Death for the last Twenty Years, extracted from 
the Registrar-General's Reports for 1852-1871, at the end of this volume. 

tit is a cause for the serious consideration of the political economist that 
—as we are informed by the Registrar-General, the death-rate in 1879, both 
in males and females, fell much below the average— there was by no means 
a fall in the rate at each separate period of life. The saving, according to 
the same authority, was entirely in young lives, and the death-rate of persons 
advanced in life, so far from falling, was much above the average.— (Report 
for 1881.) 



THE NORMAL MAN. 49 

It is to be feared that even this is much above 
the reality, for certificates of death are often given 
without adequate knowledge, and any physician of 
extensive experience will shrink from stating that 
anything like 6*5 per cent of deaths that have come 
under his personal knowledge could legitimately be 
set clown to a simple wearing out of the vital 
powers, as implied by death from old age. We 
should be afraid to assert that we could attribute 
more than one of the many deaths that we have 
witnessed, during more than thirty years of pro- 
fessional life, to old age, strictly speaking ; that is, 
where the termination of life could be attributed 
solely to the natural wearing out of the machinery, 
uncomplicated with active disease. 

Hufeland, in his " Art of prolonging Life," asserts 
that no bachelors attain advanced age ; and it is also 
stated that no idler, which means no man without a 
professed occupation, becomes very old. To both 
these rules the solitary instance in our memoranda 
formed a marked exception. 



CHAPTER III. 

THE DUTIES OF THE MEDICAL OFFICER. 

The regular employment of medical men to examine 
candidates for life insurance is a practice of com- 
paratively recent date. The custom of the old 
offices, prior to about 1820, was for each life pro- 
posing, to sign a very distinct and binding declara- 
tion, to the effect that the individual had not had 
" cow or small pox, or any other disease tending to 
shorten life." No mention seems to have been 
made of family history. The proposer had to give 
a reference to " two persons of good repute, one, if 
possible, of the medical profession." Parties who 
did not appear before the directors, or who could 
not refer to a medical gentleman, were required to 
give a reference to three persons.* 

Since that time the entire aspect of life insurance 
business has undergone a change ; and while the 
companies have learned to appreciate the value of 
skilled medical advice, the members of the medical 
profession have acquired a direct pecuniary interest 
in promoting to their utmost the great, social and 

* See History and Constitution of the Equitable Society, 
by William Morgan, F.R.S. 



THE DUTIES OF THE MEDICAL OFFICER. 51 

economic principles which underlie insurance trans- 
actions. We have tried in vain to ascertain ap- 
proximately the amount of honoraria paid in this 
way to the medical profession ; but a little reflection 
will teach the reader that it must be very consider- 
able, seeing that there is scarcely a medical man in 
the kingdom who is not more or less often applied 
to for his opinion as to the value of lives for 
insurance. 

The duties which the medical officer of an in- 
surance company undertakes to perform are ol a 
very responsible character, as they involve both the 
happiness of the applicant and the welfare of the 
company. The rejection of a candidate not only 
interferes with his plans of making provision for his 
family, but implies the existence of a morbid taint 
or of actual disease, calculated to abridge his life, 
which he may not have suspected, and the revela- 
tion of which is likely to create serious alarm. If 
the examination is carefully conducted, and facts 
bearing upon the prospects of the life of the indi- 
vidual are overlooked or falsely estimated, the office 
will be mulcted by having to pay a claim before it 
ought to become due. A refusal to pay may be 
justified under circumstances of serious concealment, 
of actual fraud or conspiracy ; but juries naturally 
tend to the side of the claimant's representatives, 
unless the evidence is of a very glaring character ; 
and owing to the odium entailed, and to the conse- 
quent loss of business, companies shrink from ap- 
pearing in court, unless they can bring overwhelming 
proof that they are the victims of deception, against 



52 THE DUTIES OF THE MEDICAL OFFICER. 

which they had taken every possible precaution. 
The history of life assurance reveals many instances 
of gross frauds perpetrated upon life insurance com- 
panies ; personation, forgery, and murder, have been 
employed, and frequently with success ;* these are 
not generally matters for the professional considera- 
tion of the medical adviser, who has to guard chiefly 
against attempts at concealing facts that indicate 
depraved habits and a tainted constitution. In 
examining the statements made by the applicant and 
by his friends, he has to exercise discrimination and 
judgment, so as to note any discrepancies and to 
seize every indication of impaired vitality, which a 
single personal examination often fails to show. A 
case recently came under our notice in which an 
office successfully resisted the payment of a large 
claim on the ground of the concealment of facts, 
which certainly would have prevented the accept- 
ance of the life had they been known when the 
policy was taken out. A gentleman died within a 
short time of effecting an insurance, at a distant 
continental watering-place. An accident suggested 
to the watchful and intelligent actuary that fraudu- 
lent representations had been made as to the de- 
ceased's previous health and habits. By following 
up the clue, and calling in the assistance of the 
detective department of the police, the deceased 
policyholder was shown to have been a victim of in- 
temperance, through which he had, not long before 
effecting the insurance, become the inmate of the 

* Ample illustrations are given in Mr. Francis' Annals, 
Anecdotes, and Legends of Life Assurance : London, 1853. 



THE DUTIES OF THE MEDICAL OFFICER. 53 

police cell, if not the lunatic asylum ; and the collected 
evidence proved so conclusive, that instead of the 
company being called upon to pay a claim of <£2000, 
it was mulcted only in the expenses of its inquiry. 
Tardieu* gives a curious illustration of the ingenuity 
brought to bear upon this species of fraud. A bank- 
rupt, having assured his life in Paris in December 
1864 for 100,000 francs, was reported soon after to 
have died in London of heart-disease, but it turned 
out that the policyholder had registered his own death 
in London, attended his own obsequies, and obtained a 
ship and cargo on the strength of the expected insur- 
ance. Murder and suicide have also, even in modern 
times, played a part in insurance business. Thus, for 
instance, we find in the same author a case of a Swede, 
Hoffstedt, who was insured by a man of the name of 
'Swinson with the Caisse Paternelle in Prance, with 
the understanding that Swinson was to provide the 
former with brandy for the purpose of drinking 
himself to death. The brandy was not expeditious 
enough, so arsenic was administered. Fortunately 
this was discovered, and the policy cancelled. 

We shall see that the question of temperance is 
one of great, and, unfortunately, very frequent 
difficulty. People entertain very different views as 
to where intemperance begins, and, excepting where 
its effects have already left a permanent impress on 
the system, the indications are by no means such 
as to enable the medical examiner to trace its exist- 
ence with certainty. 

* Etude Mtdico-ltgale sur les Assurances sur la Vie. Paris, 
1866, p. 109. 



54 THE DUTIES OF THE MEDICAL OFFICER. 

Although the necessity of a medical scrutiny into 
the value of all lives submitted for insurance is now 
an acknowledged fact, the manner in which the in- 
quiry is conducted varies in different offices. The 
physician had little or nothing to do in the early 
days of insurance, which was then regarded in the 
light of any other contract between two individuals 
not necessitating the interference of skilled evidence. 
But as time wore on and the conditions of the 
contract became better understood, it was found that 
neither party was in a position to value the data 
upon which it was to be based, unless the state of 
health of the applicant and the various contingencies 
bearing upon his prospect of life were duly estimated. 
The physician now became an essential aid in the 
furtherance of life insurance business. It soon 
became apparent that although he might be fully 
competent to arrive at a satisfactory result by any 
method of examination that was most convenient to 
himself, it was necessary for future reference, as well 
as to enable the Board to form an opinion upon the 
various points at issue, that his reports should be 
made in a definite and uniform manner. Hence all 
offices now require the examination to be conducted 
according to a certain rule ; and a fixed series of 
questions are issued, so that a record may be at 
hand which establishes both the bona fides of the 
policyholder and the manner in which the inquiry 
into his health was made. 

The great difficulty in framing the queries has 
consisted in steering the middle course between 
pedantic minuteness on the one hand and too 



THE DUTIES OF THE MEDICAL OFFICER. 55 

great breadth on the other. The former may prove 
vexatious to the applicant and irritating to the 
physician ; but the latter may err by not suggesting 
subjects that a careless or much-occupied practi- 
tioner may slur over or forget. The medical man 
should remember that negative evidence is often as 
important as positive indications, and that while he 
has the opportunity of a personal interview with the 
applicant, the Board, who have to decide the rate- 
able value of the life, do not possess this advantage. 
It often happens that the young practitioner, or one 
who knows little of the difficulties of framing a 
correct estimate of probabilities, resents the inquiries 
made by an office as an impertinence and as an 
imputation upon his mode of reporting ; but any one 
who will bear in mind that, important as his func- 
tions may be, the decision must ultimately rest with 
the Board of Directors, and that they are responsible 
for the general business of the office, will also admit 
that they have a right to ask for such information 
as they may deem necessary to guide them. Many 
careless and slovenly reports have come to our 
notice, and this is the less to be justified now that 
the medical profession benefit pecuniarily to a very 
large extent by the system at present in force. It 
may be laid clown as a general ■ rule that the best 
men give the most satisfactory and detailed reports, 
as they fully appreciate the aid they afford towards 
the development of a social scheme of the highest 
value and importance. 

The proposal for assurance, or the chief facts it 
contains, are submitted to the medical officer, and 



56 THE DUTIES OF THE MEDICAL OFFICER. 

the statements subscribed to, on it, are useful data 
for comparison with the facts elicited by the exami- 
nation ; nor should the replies given by the proposer's 
friends be overlooked for the same reason. The 
manner in which they respond to the inquiry about 
the temperance of the applicant frequently, affords a 
clue to further investigation, which he himself might 
withhold. 

The age is an important element, not only as 
regards the amount of premium to be paid, but 
also in reference to the vis vitalis of the individual. 
It is proper that he should appear the age he assigns ; 
but while it cannot be regarded as otherwise than 
generally favourable if he should look younger, it 
is decidedly the reverse if he looks much past his 
registered age, as this indicates precocious develop- 
ment in the young ; and in those who have attained 
full manhood it is a sign of premature decay, 
depending, possibly, upon the anxiety and depression" 
of business, upon exhausting diseases or excesses, or 
simply upon want of the normal vigour. In any of 
these cases the prospect of longevity would be reduced. 

As the rates of insurance are based upon the 
calculated prospect of life at each age, the medical 
man need be under no apprehension in recommend- 
ing persons of advanced age, who are in good 
average health, to insure. Our own experience 
accords with the conclusions arrived at by Mr. 
Neison, that the generally received opinion as to 
the insecurity of old lives * is fallacious, and that 

* On the Medical Estimate of Life for Life Assurance by 
Stephen Ward, M.D. London, 1857. 



THE DUTIES OF T&E MEDICAL OF! ICZR. 57 

they are paying risks. They have passed through 
the dangers that beset early life, have learned how 
to take care of their health, and have probably at- 
tained that competency and contentment which are 
among the best guarantees for a prolonged existence. 
The effects of intemperance, as proved by Mr. 
Xeison, exhibit themselves chiefly at a comparatively 
early age, the maximum rate of mortality in intem- 
perate lives occurring between 41 and 50, so that a 
person who at that age gives evidence of habitual 
temperance has escaped one of the most prevalent 
causes of degeneration of the tissued, and may boast 
of his age being 

" As the lusty winter, 
Frosty but kindly." 

Tables of the calculated expectation of life ought 
to be in every medical practitioner's hands when he 
is called upon to give an opinion on the prospects of 
an individual. We shall subjoin one that is gene- 
rally employed. 

But there are easy methods for roughly deter- 
mining the average expectation of life in England, 
such as that proposed by Mr. Willich.* He considers 
the expectation equal to two-thirds of the difference 
between the age of the individual and 80. Thus for. 
a person aged 20, this difference would be 60, of 
which two-thirds, or 40, would give his probable 
duration of life. 

* Quoted by Tardieu in Etude Mi dico-legale sur les 
Assurances sur la Vie: Paris, 1866; a translation, with notes 
of Dr. Taylor's Chapter on Life Assurance, in his Principles 
and Practice of Medical Jurisprudence, 1865. See also, 
Popular Tables, etc., by C. M. Willich, p. 176. 



58 THE DUTIES OF THE MEDICAL OFFICER. 

Mr. Walford* proposes a somewhat different proce- 
dure, which yields similar but not identical results. 
He directs us to use the fixed number 96, from 
which the ages ranging from 20 to 45 are to be 
deducted ; the half of the remainder gives the ex- 
pectance. According to his method, a person aged 
20 would have an expectancy of 38 ; for 96 — 20 
=76 ; this divided by 2, gives 38. 

In order to approximate the result of the some- 
what rough calculation previously given more closely 
to the Carlisle tables, Mr. Willich proposes the fol- 
lowing expressions : — 

From the age of 5 to 60 — 

§ of the difference between the age and 81 J = expectation. 
From the age of 60 to 74 — 

£ of the difference between the age and 88§ = expectation. 
From the age of 74 to 90— 

\ the difference between the age of 103 = expectation. 

None of these methods are quite accurate. When 
great precision is required, recourse must be had to 
Mr. Milne's mortality tables. The expectancy of 
life calculated by him, and known as the Carlisle 
tables, from the age of one to 80 are given on the 
following page : — 

* Insurance Guide and Handbook, p. 163. 



THE DUTIES OF THE MEDICAL OFFICER. 



Average Duration of Life from 1 to 80 years of age, 
according to carlisle mortality. 



Years old. 


Expectancy. 
Years. 


Years old. 


Expectancy. 
Years. 


Years old. 


Expectancy 
Years. 


Birth 


38} 


27 


36^ 


54 


18| 


1 


44} 


28 


35f 


55 


17f 


2 


47i 


29 


35 


56 


17 


3 


50 


30 


84} 


57 


16| 


4 


50f 


31 


33f 


58 


m 


5 


51* 


32 


33 


59 


15 


6 


511 


33 


32J 


60 


14i 


7 


51 


34 


31} 


61 


14 


. 8 


501 


35 


31 


62 


13* 


9 


4-03 


36 


301 


63 


13 


10 


49 


37 


29} 


64 


12$ 


11 


,48 


38 


29 


65 


11| 


12 


4?i 


39 


281 


66 


"* 


13 


46J 


40 


27} 


67 


iof 


14 


45} 


41 


27 


68 


m 


15 


45 


42 


201 


69 


»* 


16 


441 


43 


25| 


70 


H 


17 


43J 


44 


251 


71 


8! 


18 


43 


45 


241 


72 


H 


19 


42* 


46 


24 


73 


7f 


20 


41* 


47 


231 


74 


H 


21 


40f 


48 


221 


75 


7 


22 


40 


49 


22 


76 


6! 


23 


39J 


50 


211 


77 


H 


23 


38} 


51 


201 


78 


H 


25 


38 


52 


19J 


79 


5| 


26 


371 


53 


19 


80 


-H 



60 THE DUTIES OF THE MEDICAL OFFICER. 

After examining a life, the medical officer is 
expected to estimate, with all the data at his com- 
mand, how far the individual's prospects appear to 
tally with the average ; or what would, in the case 
of any deteriorating influences, be the fair allotment 
of advance upon the tabular rate. There must nec- 
essarily be much uncertainty in the conclusion arrived 
at ; still it should not be regarded as mere guess- 
work, as increasing precision is the result of in- 
creased knowledge and experience. It would be well 
if every medical man, before advising the addition 
to the tabular rate on account of unfavourable family 
history or personal defect, were to ask himself what, 
under the circumstances, the probable duration of 
the applicant's life would be. By comparing his 
private estimate with the normal prospect of life at 
the applicant's age, and deducting the difference, he 
would at least show that his advice was based upon 
some intelligible principle. At present the sugges- 
tions offered by gentlemen of limited experience 
often show that they by no means appreciate the' 
real question at issue, inasmuch as they state cir- 
cumstances that materially affect the applicant's 
viability, and suggest additions to the tabular rate 
quite incommensurate with the manifestly increased 
risk to the office. Three or four years' addition is 
often recommended by medical men, where nothing 
less than ten or fifteen would cover the individual 
risk. What should be considered is, how much is 
a disease or defect in the family history of an indi- 
vidual likely to diminish his average longevity, as 
compared with a person without such a flaw in his 



THE DUTIES OF THE MEDICAL OFFICER. 61 

antecedents. If the life is 30 and the answer is 10 
years, the addition should be 15 years extra; i.e., the 
expectation is 31| at 30 and 24| at 45, and the 
addition should be the difference between 30 and 
45, or 15. 

The occupation of the individual proposing to in- 
sure his life exercises an important bearing upon the 
estimate of his prospects. Some employments are 
more healthy than others ; some offer more direct 
risk of accident or temptation; some promote the 
taint of disease discovered in an applicant ; some 
tend to neutralise it. A person with a weak heart 
might be insurable if he belonged to such a station 
of life that he might be able to take all the requisite 
care ; whereas if lie were engaged in a laborious 
trade early death might be expected. 

The residence is also to be considered, though, of 
course, no insurance company can bind its policy- 
holders to very narrow limits ; and with the in- 
creased facility of communication, probably all re- 
strictions will be modified if they cannot be entirely 
removed. As a general rule, town districts are less 
healthy than country districts ; thus, in 1840, the 
annual mortality of every 

1,000,000 in England was 27,073 in towns, 

Do. do. 19,30*) in country districts, 

giving a difference against town districts . . . 7,773 

the population being in country districts 199, in 
town districts 5108 to the square mile.* 

* Some interesting facts bearing upon this subject may be found in a 
pamphlet On the Population Question, by Dr. Dr\>dale, being a paper (with 
the discussion thereon) read before the Medical Society of London in 1879. 
It is not within the province of this book to consider the theory which Dr. 
Drysdale bases upon his facts, but I cannot forbear putting before my readers 
the following interesting remarks which he quotes from a pamphlet by Mr. 
Edwin Chadwick, On the Dwellings of the Wage Classes (1877), and which 
has an important bearing upon the manner in which we should handle aver- 
ages— " A death-rate which is a mean of the death-rates of the whole popu- 



62 THE DUTIES OF THE MEDICAL OFFICER. 

The following table exhibits the great variations 
that occur in the mortality of the population of 
England in different localities and occupations ; the 
extremes of the averages show a variation of 19 
years and 8 months between the healthiest and un- 
healthiest localities : — * 



The Gentry Tradesmen 


Laborers 


General 




live. 


live. 


live. 


average. 




Years. 


Years. 


Years. 


Yrs. Mon. 


In Rutlandshire 


52 


41 


38 


43 8 


Town of Truro 


40 


S3 


28 


33 8 


" Derby 


49 


38 


21 


36 


" Manchester 


£8 


23 


17 


25 


" Bolton 


34 


23 


18 


25 


" Bethnal Green 


45 


26 


16 


29 


" Leeds 


44 


27 


19 


30 


" Liverpool . 


35 


22 


15 


24 



When we go into more detail we find still greater 
variations among the various modes of life. Our 
sovereigns, with all the cares of their position and 
the risks it entails, show a better average than any 
sovereigns in the world, for the average duration 
of life of thirty-five successive English rulers is 52*03 
years. It is, however, to be observed that their 
expectation on their accession to the throne was 83 
years, so that the average ought to have been 63. 
The average duration of life of great statesmen is 
56 years ; but on the whole the professional classes 
present the most favourable aspect, considering the 
risks run and the harassing anxieties they submit to. 
Dr. Guy finds that the average life of the learned 
professions collectively is 76| years, and he gives 
medical men the highest position, which is surpris- 
ing to those who note the large number of deaths 

lation, is almost invariably a pernicious representation. Thus we have part 
of a sab-district of London, comprising houses in good condition, where the 
death-rate does not exceed 11 U in 1,000, whilst there are adjacent dwellings 
within the same sub-district where the death-rates rise to the extent of 38 in 
1 ,000 from year to year. A mean of the two is a misrepresentation of both. 
It is now reported there are particular localities in London where the death- 
rates are, from year to year, upwards of 50 per 1,000.'' 
* Walford, p. 75. 



THE DUTIES OF THE MEDICAL OFFICER. 63 

among students and young practitioners from dis- 
eases caught in the exercise of their profession. 

Among the trades the mortality varies much — the 
most unfavourable occupations being those of the 
miner, the butcher, baker, and the inn and beer-shop 
keeper, as shown by the following statement of the 
Registrar-General. At the age of 45 to 55 the gen- 
eral mortality of England is 18 per 1,000 ; but while of 

1,000 farmers .12 died. 

,, hhoemakers . . . . . . 15 ,, 

,, blacksmiths, carpenters, tailors, and labourers . 17 „ 

we find that of 

1,000 miners* 20 „ 

,, bakers . . . . . . . 21 ,, 

butchers . . .. . . . 23 „ 

,, inn and beer-shop keepers . . . 28 ,, 

For these trades, apart from any individual taint, an 
advanced rate may be fairly demanded. "With the 
last category the mortality is so great that many 
persons interested in life insurance would exclude 
them from its benefits altogether. Nothing, how- 
ever, is more certain than the improvement of the 
sanitary condition and the prospect of life of the 
great bulk of the population ; f and, therefore, it is to 
be hoped that each of these trades will continue, as 
they have already done to a certain extent, to rectify 

*Dr. Allen (Medical Examinations for Life Insurance, New York, 1872) 
puts the most dangerous trades in the following order:— 1. Brakesmen on 
freight trains; 2. Burr sawyer; 3. Circular sawyer; 4. Powder-makers; 5. 
Seamen. 

t' 1 In the town of Geneva the probability of life, i. e. the age to which half 
of the population born lived, in the sixteenth century, did not exceed 5 years, 
whilst the mean of life was only 18£ years. In the eighteenth century these 
figures had risen to 27£ years for the probability of life, whilst the mean of 
life had advanced to 32 1-5 years. England has had a similar history and a 
rapid fall in the death-rate during the earlier decades of this century.' 1 Dr. 
Drysdale: The Population Question. See also on this subject a very interfer- 
ing paper by T. A. Welton, F.S.S., On Certain Changes in the English Kates 
of Mortality, 18S0: Stanford, London. 



g4 THE DUTIES OF THE MEDICAL OFFICER. 

those sanitary irregularities which seem to be a part 
and parcel of their business. Mariners are, unfor- 
tunately, also " bad" lives ; for while drowning is the 
cause of only 1 per cent of deaths in our male popu- 
lation, Mr. Barbeii* tells us that 35 per cent of deaths 
among seamen are attributable to accident. Among 
miners the proportion is 25 ; among engine attend- 
ants, 15 ; and among painters, plumbers, and glaziers 
it is 10 per cent. With regard to mariners, we would 
remark that this large mortality is essentially due to 
sea risks, and depends upon the dangers of wind and 
water, and not upon points directly affecting their ex- 
pectation through disease. In speaking of the influ- 
ence of railway travelling upon health, we shall place 
a table before the reader exhibiting the comparative 
liability to sickness which it appears to entail upon 
various members of the community. From this it is 
to be inferred that while railway officials lose a larger 
number of days by illness than any of the others, mari- 
ners are not only better off than this class, but enjoy 
a much greater immunity from sickness than the popu- 
lation at large. We do not know that this point has 
been duly considered by actuaries, for it would almost 
seem as if the two liabilities balanced one another. 

The mortality in some of the trades has been ma- 
terially diminished since public attention has been 
'directed to the subject. 

It is very encouraging to the medical profession, 
little public honour though it has received for its 
achievements, to find that owing to its energetic repre- 

* Mortality Experience of the Prudential Assurance Com- 
pany, by Henry Harben. 1871. 



1HE DUTIES OF THE MEDICAL OFFICER. 65 

sentations the mortality in the army has been reduced 
considerably more than one-half within the last fifteen 
years. The mortality of the army — although it con- 
sisted of picked men, 30 to 40 per cent of the candi- 
dates for enlistment being rejected — was described by 
Deputy Inspector-General Marshall, more than twenty- 
five years ago, as presenting a higher rate of sickness 
and a greater mortality than that prevailing at the 
same period of life in the general population. It is 
creditable to the good sense of our authorities that, 
thanks to Professor Aitken, we are able to show 
national amendment in this respect, as exhibited in 
the following tabular view of deaths occurring annually 
between 1830 and 1836, and between 1859 to I860, 
respectively, both at home and in our colonies : — ■ 

Deaths among the Troops serving in the United 
Kingdom annually per 1000 Men. 

1830 to 1836. 1859 to I860. 
Cavalry of the Line .... 15 6 

Royal Artillery 15 7 

Foot Guards 21 9 

Infantry of the Line .... 17 8 

The returns for the Colonies exhibited a similar 
reduction :— 

*The reduction of severity of syphilis by the Contagious Diseases' Acts, 
in the army, is well shown in the evidence given before the Parliamentary 
Committee in 18S1, especially that of Surgeon-Major Lawson (Minutes, p. 73 
seqq.)\ — "The outcome for the committee is that from 1S61-1SG6 at the 
stations under the Acts the admissions for secondary syphilis were 37'4 per 
thousand; from 1887-1872 they were 24;5 per thousand; from 1873-1878 they 
were 22 per thousand. Going to the stations that were never under the Acts, 
from 1861-1S66, the admissions for secondary syphilis were 30 ? 7 per thousard; 
from 1867-1872 29'4 per thousand; and from 1873-1878 30*2 per thousand; 
showing a great decrease at the stations under the Acts, while at those not 
under the Acts the numbers are virtually the same throughout, or at least 
there is very little difference. At the stations under the Acts the decrease 
was from 37*4 to 22 per thousand." 



66 THE DUTIES OF THE MEDICAL OFFICER. 

1837 to 1856. 1859 to 1861. 

Gibraltar ...... 22 9 

Malta . .18 14 

Ionian Islands 27 9 

Bermuda ...... 35 11 

Canada ...... 20 10 

Jamaica 128 27 

Special rates are necessarily charged by all insur- 
ance companies for persons serving in or visiting 
tropical climates ; and when they go to specially 
hazardous localities, like the West Coast of Equa- 
torial Africa, insurances can only be effected under 
particular agreement. With regard to trades, it is 
the custom to add 10 to 20 per cent, to the premium 
for innkeepers, for their trade alone ; a special rate 
is also universally adopted for all seafaring people, 
amounting generally to 25s. or 30s. on the sum 
assured. Other trades are not generally charged 
specially, but their influence on health and in devel- 
oping any special taint must be considered by the 
medical man. A laborious trade, for instance, would 
tend to foster the seeds of heart complaint, which in 
a person leading a very quiet life might cause no 
apprehension. A candidate showing a phthisical 
taint would be regarded more favourably if his 
occupation involved an open-air life rather than one 
of close confinement. 

The question of Temperance is unfortunately one 
to which the special attention of medical officers has 
to be directed, both in the case of male and female 
candidates for insurance. The difficulty that we 
have to deal with consists in the very great latitude 



THE DUTIES OF -THE MEDICAL OFFICER. 67 

in the definition of intemperance. But for the pur- 
poses of life insurance the broad line may be laid 
down, that the habitual spirit-drinker, and especially 
one who is found to take strong drinks early in the 
day, ought to be declined altogether. The beer and 
wine drinker does not shorten his life frequently by 
excess, but there is scarcely a degenerative condition 
of the body that may not result from the abuse, or 
rather the habitual use, of ardent spirits.* 

It is doubtful whether teetotallers can be regarded 
as very good lives, because they are frequently re- 
formed drunkards ; but when they have been advo- 
cates of the system before they had committed any 
excesses, or when they have taken the pledge before 
degenerative changes had occurred in the body, one 
cannot doubt that the teetotaller may be regarded 
as a good life. "The reformed drunkard," as Dr. 
Brinton f justly observes, " is not a good life ; his 
repentance, as regards his physical constitution, often 
comes too late. Many months or even years of the 

* The earliest historical records of humanity are evidence that the vice of 
intemperance is not one of modern origin. The distinction between wine 
and strong drinks was certainly recognised in the Pharaonic times, or Aaron 
would not have been commissioned to pronounce such a command as—'* Do 
not drink wine nor strong drink, thou, nor thy sons with thee, when ye go 
into the tabernacle of the congregation, lest ye die.'" (Leviticus x. 9.) The 
warnings against strong drink, as distinct from wine, are too frequent in the 
Old Testament to permit a doubt of the abuse of ardent spirits having 
existed in primeval times. No modern physician could more pungently 
declaim against the matutinal dram than the prophet when he says— "Woe ' 
unto them that rise up early in the morning, that they may follow strong 
drink; that continue until night, till wine inflame them." (Isaiah v. 11.) 

t On the Medical Selection of Lives for Assurance, p. 18. 



68 THE DUTIES OF THE MEDICAL OFFICER. 

most complete abstinence scarcely suffice to restore 
his probabilities of existence to a level with those of 
the temperate user of alcohol. Setting aside the not 
inconsiderable chances of his relapsing into old 
habits, his constitution often seems to have a pecu- 
liarly treacherous character ; its apparently robust 
health consuming away with unusual rapidity under 
a moderately severe attack of any acute disease." * 
The medical man can scarcely expect to receive a 
denial of temperate habits from an applicant for in- 
surance ; but if, from the reports of friends, or from 
noting symptoms of dyspepsia, or from a history of 
" biliousness," a furred tongue, a quickened pulse, 
irregular flushing, tremulousness, and similar indica- 
tions of alcoholic excesses, he suspects* alcoholism, he 
must direct his questions to the exact frequency and 
quantity of the applicant's libations. Wherever the 
result of the inquiry is doubtful, the benefit of the 
doubt should be given to the company. The physi- 
cian's gallantry must not mislead him when dyspeptic 
and anomalous nerve systems indicate alcoholism, 

* In a paper read before the Society of the Medical Officers of Health in 
1877, Dr. Edmunds compares the deaths occurring in the Temperance and 
General Provident Institution, composed of two classes: total abstainers and 
moderate drinkers. He finds that among the moderate drinkers one death 
occurred per annum for every 152 insurants, among the abstainers one death 
for every 201 insurants ; on the other hand, after analysing the causes of 
disease under the heads of diseases of the nervous system, of the liver and 
kidney, lung disease, heart disease, zymotic diseases and casualties, he arrives 
at the conclusion that 461 (out of a thousand) died of these diseases, where 
401 moderate drinkers died, the abstainers dying to the extent of 15 per cent, 
in excess of moderate drinkers. It is manifest that the question of total 
abstinence, versus moderate drinking, cannot as yet be regarded as finally 
settled. See also on this subject a letter by Dr. Edmunds in The Sanitary 
Record, Jan. 18, 1878. 



THE DUTIES OF THE MEDICAL OFFICER. 69 

in the female ; unfortunately the vice of secret dram- 
drinking is met with in the best families, sometimes 
unknown to any but the victim ; at others it is recog- 
nised by members of the family, but is concealed * by 
them even from their medical attendant for very shame. 

Excess in drinking is admitted by all physicians 
to be the frequent direct and indirect cause of fatal 
illnesses. Gluttony is less to hi regarded as a cause 
of mischief, because the s\\ tern more readily adapts 
itself to a certain excess of alimentary supplies ; and 
solid food not being so easily taken up and assimi- 
lated, a check takes place spontaneously to the 
introduction of more than a given quantity of solid 
food. The truly temperate man takes as much food 
and beverage as he requires for the clue performance 
of all his functions, and not more of one or the 
other ; and the common experience of man, which 
is supported by scientific observation, is to the effect 
that our ordinary food goes farther and lasts longer 
if with it we consume a quantity of beer or wine, 
enough perhaps to exhilarate, but not sufficient to 
confuse or weaken the intellectual powers. 

The questions generally put to the applicant for 
insurance embrace inquiries into his previous health, 
the health, or date of death, of his parents and 
brothers and sisters ; and, if it is a woman, 

* This is a literal fact within the author's experience, who 
was called in to see a lady, in consultation, when she was 
moribund from alcoholic poisoning. The medical attendant, 
who had attended herself and other members of the family for 
years, had never before been called in to advise when she had 
suffered from slighter attacks of the same kind; but on the 
occasion in question alarm was created, and the vicious pro- 
pensities of the patient were revealed. 



70 THE DUTIES OF THE MEDICAL OFFICER. 

special inquiries are added with reference to utero- 
gestation and the uterine functions generally. 

Life insurance is one of the indirect means by 
"which vaccination is promoted, as it is always in- 
sisted upon where it is found to have been pre- 
viously neglected.* 

Female expectation is generally about three years 
in advance of males ; but it does not appear that 
this advantage is perceived In life insurance, where 
the mortality among the female is larger than that 
of the male policyholders. The reader must form 
his own hypothesis as to the cause of this apparent 
contradiction ; we fear he can scarcely arrive at a 
solution that is quite satisfactory. Unless a direct 
interest can be proved, as where the benefit of the 
wife's settlement is lost to the husband in case of 
her death, the husband can scarcely be permitted to 
insure his wife's life. Instances have come under 
our notice of early death having occurred after the 
rejection of an application by a husband to insure 
his wife ; even when no foul play has occurred, it 
may be inferred that the husband was acquainted 
with -some constitutional infirmity that was not 
generally apparent. The Married Woman's Property 
Act now enables a married woman to assure her own 
life under more convenient terms ; and it may be 
confidently asserted that larger numbers of insur- 

*It would be interesting if all the insurance offices would 
publish their experience with reference to smallpox. The 
author's experience leads him to fear that vaccination is often 
most inefficiently performed ; for one office with^ which he is 
associated had no less than 18 claims during the recent epi- 
demic, in consequence of deaths from smallpox in persons 
who had been vaccinated. 



THE DUTIES OF THE MEDICAL OFFICER. 71 

ances will be effected by females in consequence. 
The peculiar influences which render the lives of 
assured females worse than the unassured lives of 
males, seem worthy the attention of the medical man. 
Prior to 1772 they were charged more than males. 

Parturition in the healthy female ought not to 
affect the prospect of life generally ; and, excepting 
for primiparae, is not generally regarded by insur- 
ance companies as justifying an advance upon the 
average premiums. The unfavourable statistics of 
parturition refer to periods and places where and 
when the sanitary laws were set at defiance or 
neglected, and when the value of pure air was 
ignored in lying-in rooms, as in the sick chamber 
generally ; still the average is not now as favourable 
as it ought to be. The following table, compiled by 
Soiithw-ood.Smith,* shows the fearful results, on the 
one hand, of the neglect of sanitary precautions, and, 
on the other, the comparative immunity from dangers 
of the parturient female under opposite conditions . — 
Mortality of lying-in women in — 

Hotel Dieu, Paris . . in 1786 

Prussia . . . 1817 

British Lying-in Hospital, London 1750 
Do. do. .. 1780 

Do. do. . 1789-1798 

Lying-in Hospital, Dublin . 1822 

Town of Lewes . . 1820-1835 

It is to be regretted that Lewes can only be re- 
garded as an exceptionally favourable specimen, 
because, according to Dr. Farr,f the general mortal 

* Philosophy of Health, vol. i. p. 139. 

t Fifteenth Annual Report of the Registrar-General. Ap- 
pendix, p. 69. 



1 in 


15 


1 in 


112 


1 in 


42 


1 in 


60 


1 in 


288 


1 in 


223 


1 in 


1205 



72 THE DUTIES OF THE MEDICAL OFFICER. 

ity of parturient females was considerably greater 
at a much more recent period ; he shows that in 
England one mother died for 192 children born alive, 
in the years 1851 and 1852. This average is im- 
proved when we take the longer period of twenty-five 
years from 1847 to 1871, during which, according to 
the Registrar-General's Report for 1871, published 
during the present year (1873), the number of 
deaths of mothers to 10,000 children born alive 
was 49, or 1 in 204 parturient women. Pregnancy 
has always been regarded as a woman's safeguard ; 
but we should scarcely have been prepared for such 
complete immunity from fatal disease as indicated 
by the Registrar-General, who tells us that in 1871 
only 35 pregnant women died.* The progressive 
improvement in the statistics of midwifery shown 
above is further borne out by the two following 
tables, which Ave borrow from Sir James.. Simpson's 
works, f 

1. Average Number of Mothers dying in childbed in 
London, from 1660 to 1820. 
1660 to 1680 .—1 death in every 44 delivered. 



1680 to 1700 


1 


55 


ZQ 


1700 to 1720 


. 1 


j? 


69 , 


1720 to 1740 


1 


?? 


71 


1740 to 1760 


1 


it 


77 , 


1760 to 1780 


1 


55 


82 


1780 to 1800 


1 


55 


110 


1800 to 1820 


1 


55 


107 , 



* Registrar-General's Report, 1871, p. 250. 
t Obstetric Memoirs and Contributions, by James Y. Simp- 
son, M.D. Edin. 1856, vol. ii. p. 543. 



THE DUTIES OF THE MEDICAL OFFICER. 73 

2. Proportion of Deaths in childbed in England and Wales, 
from 1839 to 1842. 



fears. 


No. of child- 
dren born. 


No. of mothers 
dying in 
childbed. 


Proportion of ma- 
ternal deaths in 
childbed. 


1839 


492,574 


2915 


1 in 169 


1840 


502,303 


2989 


1 in 168 


1841 


512,158 


3007 


1 in 170 


1842 


517,739 


2G87 


1 in 182 



In considering the influence of parturition upon the 
prospect of life of an individual, we may, excepting 
in the case of primiparae, be guided by the account 
received of previous labours ; and if they have been 
normal, we are not called upon to advise an advanced 
premium where the insurance is for the whole life. 

When it is effected during pregnancy as for 
female lives generally, we have special regard to col- 
lateral circumstances, and inquire into the interest 
which a husband has, if he be taking out the policy. 
Strange revelations might be made under this head ; 
but as they involve moral rather than medical con- 
siderations, they belong to the general history of 
life insurance,* and not to the topics to which it is 
desired to direct the reader's special attention. 

An important distinction is to be drawn between 
primiparae and multipara in regard to the clan- 
ger of parturition. Dr. Allen f illustrates their 

* Those curious in this peculiar development of moral obli- 
quity will find ample food for reflection in The Annals, 
Anecdotes, and Legends of Life Assurance, by John Francis 
(London, 1853), which contains numerous illustrations of the 
frauds practiced upon life insurance companies. 

f Medical Examinations for Life Insurance, by J. A. Allen, 
M.D. : New York, 1872, p. 175. 



74 



THE DUTIES OF THE MEDICAL OFFICER. 



relative position by the following tabular statement, 
the details of which are collected from several 



sources :- 



Authority. 


No. of 
primiparse. 


No. of 
deaths. 


One death 
in every 


No. of 
nnrltiparae 


No. of 
deaths. 


One death 
in every 


Hardy and / 
Maclintock j 

Matthews ) 
and Duncan J 

Johnson / 
andSinclair j 


2,125 

3,722 
4,535 


35 
50 

83 


60 
74 
54 


4,510 

12,671 

9,213 


30 
103 

80 


150 
123 
115 


Totals 


10,382 


163 


62 


26,394 


213 


124 



It follows from these statistics that, however 
much we may be disposed to regard parturition as a 
natural and healthy function, the human female is 
certainly exposed to a certain amount of danger, 
which, in those who have not borne children before, 
fully justifies insurance companies, irrespective of 
any other considerations, in charging a special rate, 
which, however, may be remitted when the process 
has been accomplished, or when the period of child- 
bearing has come to an end. 



CHAPTER IV. 

HEREDITARY INFLUENCES. 

Haying recently surveyed generally the medical 
aspects of life insurance, as indicated by the in- 
quiries addressed to the candidate and his friends, 
we now proceed to a more detailed examination of 
the questions connected with the past history and 
the present health of the individual. 

In the past history, the health and duration of 
life of his near relatives form most important items, 
involving as they do the influence which they exert by 
the hereditary transmission of good or bad qualities. 
The principle has been recognised from the earliest 
history of man by Scriptural authority and by pro- 
fane writers, and is daily receiving fresh illustration 
and being made more precise in its practical appli- 
cation. The truth of Horace's 

" Fortes creantur fortibus et bonis," 
no less than its converse, is daily verified by the 
records of life insurance. For this reason the in- 
quiries addressed to a future policyholder as to his 
family history should never be lightly passed over. 
We constantly find that, even where the individual 
applicant presents an unimpeachable personal his- 
tory, the hereditary taint manifests itself sooner or 



'76 HEREDITARY INFLUENCES. 

later in impaired vital power and in premature 
death. 

We seek for evidence of inherited peculiarities 
in progenitors, in collaterals, in descendants, and in 
the person of the candidate for insurance. " As a 
general rule," we may say with Dr Guy,* " it will not 
be necessary to extend the inquiry beyond the father 
and mother, and the brothers and sisters, if the an- 
swers regarding them prove favourable ; but if these 
near relations have died early, or if they appear to 
be subject to some hereditary malady, seriously 
affecting the duration of life, it may be necessary 
to include in the inquiry a larger circle of relation- 
ship,'"! 

The question presents itself to us under two 
aspects, which we would consider as direct and as 

* Principles of Forensic Medicine, by W. A. Guy, M.B., 
F.R.S., London, 1868, p. 139. See also, Aitken's Science and 
Practice of Medicine, vol. i. p. 392. 

t Hippocrates evidently entertained- a strong opinion as to 
the importance of hereditary influence. In his essay on the 
sacred disease, or what we term epilepsy, he says : "Its 
origin is hereditary, like that of other diseases. For if a 
phlegmatic person be born of a phlegmatic, and a bilious of a 
bilious, and phthisical of a phthisical, and one having spleen 
disease of another, having disease of the spleen, what is to 
hinder it from happening, that when the father and mother 
are subject to this disease, certain of their offspring should be 
so affected also ? As the semen comes from all parts of the 
body, healthy particles will come from healthy parts, and un- 
healthy from unhealthy parts.*' The last paragraph, though 
not expressed in the language of modern science, really con- 
tains the whole pith of the matter. (The whole works of 
Hippocrates, translated by Francis Adams, LL.D., Sydenham 
Society's Edition, vol. ii. p. 447.) 



HEREDITARY INFLUENCES. 77 

indirect liereditariness. The former implies the con- 
veyance of a definite morbid taint from one genera- 
tion to another ; under the latter we understand the 
production of constitutional peculiarities not trace- 
able to actual disease, but due to accidental circum- 
stances affecting the embryonic condition of the 
individual, and influencing his future development. 
Many of the data are extremely difficult to obtain ; 
and fortunately for mankind it is also true, that edu- 
cation and training may neutralise and divert the 
morbid impulse imparted to offspring ; but the more 
the physician iiiquires into the private history of 
families, the more ground will he discover for his 
belief in the doctrine of hereditary influence. As 
yet, our knowledge on the subject is but very frag- 
mentary, but it is one that largely concerns the 
schoolmaster, the political economist, and the philan- 
thropist, as well as the physician; and it is to be 
desired that some Hercules in science may arise be- 
fore long, not only able to gather up all the disjecta 
membra, but also to give shape and precision to 
many views that still possess no firmer basis than 
tli at of vague hypothesis. 

Indirect liereditariness is a term we would apply 
to that departure from the healthy standard which 
may be traced to conditions not involving ill health 
on the part of the parents, but still known to induce 
a low state of vitality in their offspring. We re- 
ceive some remarkable illustrations bearing upon the 
influence exerted by parents upon their progeny at 
the time of conception, when there is no question of 
the existence of disease, from a study of the brute 



T8 HEREDITARY INFLUENCES. 

creation. Our readers will readily recall the account 
given in the 30th chapter of Genesis, of the process 
adopted by Jacob* to ensure the production of lambs 
of a certain colour ; and although we have no scien- 
tific data to establish ihe exact analogue in man, 
there can be little doubt that the fundamental law 
involved applies to him as well as to the' lower crea- 
tion. When we consider the persistence of impres- 
sions once made upon the tissues during extra- 
uterine life, as shown, for instance, in the perpetua- 
tion of scars, where the abnormal cell-formation once 
produced repeats itself in every fresh layer of cell- 
growth, we need not be surprised at a reappearance of 
influences exerted at one impregnation upon future 
similar events. f That a previous impregnation may 
exercise an influence on subsequent impregnations, 
is illustrated by the following fact : a seven-eighths 

* " Jacob took him rods of green poplar, and of the hazel 
and chestnut tree ; and pilled white strakes on them, and made 
the white appear which was in the rods. And he set the rods 
which he had pilled before the flocks in the gutters in the 
watering troughs when the flocks came to drink, that they 
should conceive when they came to drink. And the flocks 
conceived before the rods, and brought forth cattle ring- 
straked, speckled, and spotted. And Jacob did separate the 
lambs, and set the faces of the flocks toward the ringstraked, 
and all the brown in the flock of Laban ; and he put his own 
flocks by themselves, and put them not unto Laban's cattle. 
And it came to pass, whensoever the stronger cattle did con- 
ceive, that Jacob laid the rods before the eyes of the cattle in 
the gutters, that they might conceive among the rods. But 
when the cattle were feeble, he put them not in: so the 
feebler were Laban's, and the stronger Jacob's." 

t See British and Foreign Medical Review, July 1846, 
p. 142. 



HEREDITARY INFLUENCES. 79 

Arabian mare, belonging to the Earl of Morton, had 
her first foal by a quagga ; subsequently she had 
three other foals by a black Arabian. Now, the first 
two foals of these three by the Arabian had a strik- 
ing resemblance to the quagga in the markings of 
their coat and in the form of their mane. It is 
necessarily difficult, if not morally impossible, to 
adduce similar illustrations of the law of transmis- 
sion of qualities in the Anglo-Saxon race ; but when 
we refer to the results exhibited in the intercourse 
between white and dark races of man, we meet with 
evidence of a satisfactory character, showing that 
impressions are perpetuated at the time of concep- 
tion. 

Common observation has long established the fact 
that qualities found in one generation are transmis- 
sible, per saltum, to the second generation in descent, 
or traceable upwards in the same way ; * so that, in 
regard to life insurance, the relation between grand- 
parents and grandchildren may become a question 
of importance. The predominant influence exerted 
by one or other parent, though difficult to formularise 
with precision, is also constantly manifested in the 
greater resemblance in future, in character and in con- 
stitutional peculiarity, of the offspring to either father 
or mother. Therefore, in cases of doubt as to the 
existence of any special proclivity on the part of an 
individual, his resemblance to either of his progeni- 
tors may assist in guiding the judgment. There are 
several factors to be considered here — the previous 

*This peculiarity in the law of hereditary transmission has 
been termed Atavism. 



80 HEREDITARY INFLUENCES. 

health of the parents,* their special condition f at the 
time of sexual intercourse, the condition of the mother 
during utero-ge station ; but we should be led away 
from the practical purpose of this book if we were 
to go into details, which, in the present state of 
science, must necessarily be more or less speculative. 

There are, however, two points in the relations of 
the parents which are of undoubted influence upon 
their children, and which have been removed by 
direct observation from the domain of hypothesis. 
We allude to the influence upon the offspring de- 
pending upon great disparity of age between father 
and mother, and upon their consanguinity. 

The procreative powers arrive at maturity at the 
period of puberty, which varies somewhat in different 
climates, but is always earlier in the female than in 
the male. The vigour of the offspring depends closely 
upon the vigour of the parents ; it is not, therefore, 

* Many curious facts and observations bearing upon this 
point are to be found in Walker's work on Intermarriage, 
(London, 1838). Thus we are informed that, "if a stallion le 
prevented, even by accidental lameness, from obtaining exer- 
cise, he is sure to be deficient in muscular power, and to con- 
vey that deficiency to his offspring. I knew a horse who 
broke his leg when running a race when three years old, and 
who has since been kept for covering mares, not being capable 
of anything else, or even of travelling for that ; but his stock 
are not promising, though he is exceedingly well bred." See 
also. On the Transmission from Parent to Offspring of some 
Forms of Disease, by James Whitehead, M.D. London, 1857. 

f The experience of the reader will probably supply him 
with instances corroborative of the influence hinted at, and of 
which that profound observer of nature, the poet Gcethe, 
avails himself to give point to his remarkable psychological 
novel, Die Wahlverwandschaften. 



HEREDITARY INFLUENCES. 81 

physiologically desirable that very early marriages 
should be encouraged. There is comparatively little 
danger of men marrying too early, as in the bulk of 
the population in our country the cost of living and 
the labour necessary to insure an income adequate to 
support a wife, proves a sufficient bar to excessive 
haste. The danger is rather on the side of the female, 
where attractions too often are a cause of wiser 
considerations being set aside, and the young woman, 
dazzled by the w T ill-o'-the-wisp of independence, is 
tempted, before her frame is well knit and she is 
sufficiently developed in all her organs, to undergo 
the revolutionary changes which marriage entails 
upon her system. 

What wonder that the girl of 17 or 18, whose 
bones are only half consolidated, and w r hose pelvis, 
especially, with its muscular and ligamentous sur- 
roundings, is yet far from maturity, loses her health 
after marriage, and becomes the delicate mother of 
sickly children? Parents w T ho have the real interest 
and happiness of their daughters at heart, ought, in 
consonance with the laws of physiology, to discoun- 
tenance marriage before 20 ; and the nearer the girls 
arrive at the age of 25 before the consummation of 
this important rite, the greater the probability that 
physically and morally they will be protected against 
those risks which precocious* marriages bring in 
their train. 

There scarcely appears to be any natural 

* " Les manages trop prccoces anienent la stcrilite et pro- 
duisent des enfans qui ont moins de probability de vivre." — 
Quetelet, Sur THornine, vol. i. p. 65. 



82 HEREDITARY INFLUENCES. 

limit to the procreative powers of man after 
puberty ; * the sexual powers are often reduced v and 
annulled at an early age by excesses or by disease, 
but there are many instances on record of healthy 
men having become fathers at a period of life when 
their female contemporaries would have passed the 
reproductive age by several decennia. When a man 
in advanced life takes a partner, he too often allows 
himself to be led away from the paths of prudence 
by youth and beauty ; and we then find not only that 
the father often pays a penalty to which it is not 
now our province to allude, but that his offspring 
exhibit physical defects, which manifest themselves 
in a variety of ways, but always tend more or less to 
diminish its vital power and its prospects of longevity. 
Hence one point to be considered in life insurance is 
the relative age of the candidate's parents at the time 
of his birth. As the average age at marriage in 
England is 25, the influence we have just discussed 
does not very often present itself for our considera- 
tion, but where it occurs it should not be overlooked. 
The Mosaic law, which in so many points har- 
monises with the most recent developments of 
natural science, dwells most wisely on the question 
of consanguinity in marriage. It is one of such 

* Thomas Parr of Wilmington, Shropshire, who died 1635, 
aged. 152, married at the age of 80 for the first time, and lived 
with his wife for 32 years, but during her lifetime and 
when 105 years old, he had an illegitimate child by Cathe- 
rine Milton, for which he did penance in Alderbury Church. 
After the death of his first wife, he married again at the age" 
of 122, and had one child. — Records of Longevity, by 
Thos. Bailey : London, 1857, p. 291. 



HEREDITARY INFLUENCES. 88 

importance at the present day, that one might almost 
be tempted to regard it as an argument against the 
original unity of the race. Be that as it may, it is 
irrefragable that intermarriages among relations is 
most prejudicial upon the resulting progeny. Fre- 
quently they are barren, and that is the issue that, 
under the circumstances, might be desired for all ; 
for general debility, defects in vital organs, and espe- 
cially in the nervous centres, and a special perpet- 
uation of those vices of conformation that pre-exist 
in the parents, are the almost invariable result. If 
our divines, instead of squabbling over a canonical 
law prohibiting the widower from marrying his 
deceased wife's sister, would study physiology as 
bearing upon the laws of reproduction, they would 
probably arrive at the conclusion, that while they 
might safely leave the former question to be dealt with 
at the discretion of the persons immediately con- 
cerned, they would do a wise thing to obtain an enact- 
ment forbidding the marriage of cousins of the first 
and second degree. That sterility is a frequent pres- 
ent penalty upon the intermarriage of relatives, is 
confirmed by the fact that when one partner dies and 
the survivor marries a person with whom there is no 
trace of blood relationship, healthy children are born. 
The general law appears to be that, the more fresh 
blood is introduced into a family or race, the more 
vigorous the descendants are likely to be. 

Provided there be none of the accidental deviations 
from natural law to which we have alluded in the 
foregoing pages, we may assume it proven that healthy 
progenitors ai*e followed by healthy descendants. 



84 HEREDITARY INFLUENCES. 

We shall now consider the special influences and 
proclivities of a morbid type, which tend to reproduce 
themselves by hereditary transmission, and which 
merit a special study by all medical men ; in regard 
to their influence on longevity as connected with life 
assurance they deserve particular attention. The 
whole subject of the diathesis, or predisposition to 
special diseases, is bound up with this question. We 
have to deal with an impress transmitted from father 
to son, and from grandfather to grandson, which may 
or may not be manifested at birth, but is likely to 
appear under favouring conditions at any later period 
of existence, according to the peculiar character of 
the taint. Here again the predominant influence of 
one or other parent at the time of sexual intercourse 
exercises a palpable effect upon the offspring, other- 
wise it seems impossible to account for the escape 
of some members of the same family from an influ- 
ence to which all appear to have been equally sub- 
ject. Physical training and care may do much to 
neutralise the hereditary taint, but it is a question 
whether it can be entirely obliterated in one genera- 
tion. There is probably no limit to the possible 
reproduction of morbid conditions of tissue and 
structure, nor can we determine the range of influ- 
ence exerted upon the embryo and foetus during 
intra-uterine life, apart from the impress communi- 
cated by the paternal parent ; but for the purpose we 
have in view, we may limit our consideration to cer- 
tain well-marked features in the transmission of 

morbid peculiarities.* Syphilis, scrofula, tubercle, 

> 

*The reader will find some useful hints on this subject in Dr. Copland's 
Dictionary of Medicine, under the head of "Disease," vol. i. p. 556 



HEREDITARY INFLUENCES. 85 

cancer, gout, rheumatism, epilepsy, and insanity, 
with their allies and derivatives, are the fell names 
that here come into prominence. 

Whatever hereditary diseases appear in a well- 
marked form, the observer will not fail to recognise 
them and estimate their bearing upon the longevity 
of the individual. But in connection with life assur- 
ance, we have to deal ordinarily with a person pro- 
fessing to be in good health, and in whom the 
faintest indication of a taint must be sought for in 
order to establish its influence upon his constitution 
and upon accidental diseases that may arise. The 
hereditary taint of syphilis has long been a subject 
of earnest discussion among medical mefi, and mo- 
dern research has traced numerous lesions of vital 
organs to its influence, though these, in the adult, are 
probably more often due to the remarkable latency 
of the poison for long years after primary infection. 
The actual mortality from syphilis, according to the 
Registrar-General's reports, is but small,* and his 
data would be altogether misleading were practi- 
tioners not well acquainted with the deteriorating in- 
fluences of syphilis upon the vitality of the individual, 
which enfeebles his powers of resistance to the fatal 
diseases under which many deaths are registered, 
and which may in reality be justly classified, under 
the indirect effects of syphilis.f In many cases the 

*The Regi*strar-Generars Report for 1881 gives among the causes of death — 
Syphilis .... 1,053 males, 976 females. 

Of the males 803, of the females 690, were under the age of 1 year. 

t" Syphilis, per se, is rarely fatal in adults; but by altering the structure 
of the organs Of vital importance it renders the patient v. liable to resist the 
inroad of inflammatory action setup accidentlv. " — Syphilis and Local Con- 
tagious Disorders, by Berkeley Hill, M.D., F.E.C.S. London, 1868, p. 27. # 

"We know that the venereal dyocrasis never attacks an individual, a fortiori 
an infant, without imparting to its constitution a debility which predisposes 
it to all kinds of organic or functional affection. Acute' diseases occur more 
readily in it, or are more severe, catarrhal thesis more persistent, diathesis 
more deeply rooted.— On Syphilis in New-born Children, by P. Diday. Trans- 
lated by G. Whitley, M.D., 1859. New Syd. Soc. 



86 HEREDITARY INFLUENCES. 

effect of scrofula and some forms of inveterate 
syphilis resemble one another so closely as to have 
caused them to be regarded as identical by authors 
of eminence. Mr. Whitehead,* who has paid much 
attention to this subject, views sycosis as a congener 
of syphilis, upon which he has found it supervene, 
while he has seen phenomena simulating lues venerea 
occurring in the offspring of one affected with syco- 
sis. It is not improbable that, with the advance of 
chemistry and microscopy, we may be able to recog- 
nise the existence of this and other taints through 
direct evidence obtainable by an examination of the 
tissues and especially of the blood. Dr. Garrod, 
Dr. Sanderson, and others, have already done much 
in this direction, but we are yet far from having 
attained to a reliable method of recognising the 
diathesis, the indirect or circumstantial evidence 
being generally all that we have to build our conclu- 
sions upon. Whether, in certain cases, scrofulous 
and venereal affections are identical or not, there 
can be no doubt that the scrofulous diathesis pos- 
sesses in a marked manner the attributes of an 
hereditary malady. The glandular enlargements 
that characterise scrofula may very commonly be 
traced as belonging to several generations of* the 
same family ; just as the tumid lips, high cheek- 
bones, fair hair and complexion, broad alae nasi, 
irregular digestion, and general want of tone, re- 
garded as features characteristic of the scrofulous 
type, recur again and again in members of the same 

* Whitehead, on the Transmission from parent to offspring of some forms 
Of Disease, p. 66. 



HEREDITARY INFLUENCES. 8^ 

stock.* The scrofulous individual is more liable to 
developing any accidental diseases which attack him, 
into dangerous forms, and to be prostrated by them, 
than a person in whom no such predisposition exists. 
The former is less able to bear the shocks and trials 
of. life to which humanity is unavoidably exposed 
than the latter; caeteris paribus therefore, lie is less 
eligible for life insurance. 

We need not here discuss the question of identity 
or non-identity of scrofula and tubercle. \ye con- 
fess ourselves as adherents of the non-identity doc- 
trine, both on the ground of personal observation 
and study. But that a correlation between them, 
and furthermore with syphilis, exists can scarcely be 
denied by the advocates of either view. Certainly 
in none of the three is the hereditary character more 
palpably displayed than in tubercle or phthisis. Upon 
the general fact all writers are agreed, but they differ 
as to the exact frequency of this influence, owing to 
the different manner in which they have carried out 
their researches. The authorities of the Brompton 
Hospital for consumption inform us that they find an 
hereditary tendency in 246 out of 1010 cases, or in 
24.35 per cent; but this result is too favourable, 
unless we limit our inquiry to the antecedents of a 
patient's parents. Dr. Puller f has shown that ii 
the existence of the disease in either grandparent be 
considered as evidence of the transmission of the dis- 
ease to the grandchildren, a proposition which has 

* See Scrofula; its Nature, Causes, etc., by Benjamin Phillips, F.R.S. Lou 
don, 1846. 

tOn Diseases of the Chest, by H. W. Fuller, M.D. London. 186-2. p. 348. 



88 HEREDITARY INFLUENCES. 

our entire assent, the proportion will rise to 43. 6 
per cent ; and if the predisposing influence exhibited 
by death of uncles and aunts from consumption be 
included in the calculation, the proportion will rise 
to 59.5 per cent. 

We would go even further. For our experience 
has convinced us that we derive as important indica- 
tions from an examination of the history of collate- 
rals, as of ascending generations. In this we are 
borne out by the elaborate investigations of Dr. 
Theodore Williams.* He finds that the number of 
cases of consumption having only brothers and sis- 
ters affected with that disease constitutes a percent- 
age of 46 per cent — a percentage which, as will appear 
from the following table, is larger than that of any 
other class of relations. Of a total of 484 

10 had grandparents affected. 
43 had fathers affected. 
67 had mothers affected. 
10 had both parents affected. 
48 had uncles and aunts affected. 
72 had father's or mother's family affected (particu- 
lars unknown). 
224 had brothers and sisters affected. 
10 had cousins affected. 

Dr. Theodore Williams' analysis of cases also de- 
monstrates that the family predisposition shows itself 
more in the females of a family than in the males, the 
difference amounting to 14 per cent ; while they con- 
firm the prevailing opinion, which is commonly acted 
upon in determining the relative increase of life as- 

* On the Duration of Phthisis Pulmonalis, by C. T. Williams, M.D.— Med. 
Ckir. Trans., vol. liv. p. 95. 



HEREDITARY INFLUENCES. 89 

surance rates, that the presence of phthisis in mothers 
has a greater influence upon the recurrence of the dis- 
ease in their children, than its presence in the fathers, 
to the extent of nearly 5 per cent. 

The phthisical taint shows itself in other Avays than 
in the occurrence of tubercular disease. It appears 
to generate a special liability to disease of the mucous 
membranes ; hence the prevalence in phthisical fami- 
lies of bronchitis and pleuro-pneumonia, the ante- 
cedence of which, in an applicant for insurance, re- 
ceives greater or less significance according to the 
force of collateral evidence as to his immunity or 
the reverse, from the debilitating conditions involved 
in a 4 n hereditary proclivity. 

The proclivity to phthisis commences at puberty, 
and though the succeeding ten years are generally re- 
garded as the most fertile period of life for the develop- 
ment of this disease, this view is based upon a fallacy, 
as the disease is statistically shown to occur with 
almost uniform frequency up to the decline of life. 
After 50, the proportion of deaths from phthisis to 
those living is nearly the same as at an earlier period. 
This is particularly important in regard to life insur- 
ance, as it warns us not to disregard the hereditary 
influences iii any person offering to insure, whatever 
the age. In childhood, the tubercular predisposition, 
for reasons which it does not concern us to dwell 
upon, shows itself rather in the brain and abdomen 
than in the pulmonary tissue, and this has to be 
borne in mind in estimating the indications afforded 
by collaterals as to hereditary taint. 



90 HEREDITARY INFLUENCES. 

On the other hand, we must be careful not to 
overrate the hereditary taint of phthisis and its in- 
fluence upon life assurance. From the Report on 
second-class lives of the Equity and Law Insurance 
Company for 1878, with which I have been favoured, 
through the kindness of Dr. Symes Thompson, it 
appears that the customary additions for phthisical 
tendencies have been excessive. The table illustrat- 
ing this point shows that, " though the total deaths 
in the consumptive history class happen to be less in 
number than the normal expectation yet they have 
occurred earlier in life ; but at the same time the 
actual additions have been much more than sufficient 
to meet the extra risk." Dr. Symes Thompson con- 
siders that an addition of 3 to 5 years is adequate 
when the personal condition is good. 

Supposing we have a candidate for insurance before 
us who presents an unexceptionable personal history, 
how are we to rate various influences of an heredi- 
tary character connected with thadisease in question ? 
It seems a fair rule to add seven years where a 
father, and ten where the mother is shown to have 
been consumptive. The usage of offices is, we be- 
lieve, to disregard the death of one collateral from 
phthisis ; we question whether this is in accordance 
with the evidence we have adduced. Certainly, 
where two of the same generation have succumbed 
to the disease, an addition of 7 or 10 years is neces- 
sary. If both the parents have died consumptive, 
hazardous rates of 20 or 25 years only can be ad- 
mitted, and it is a question whether such lines ought 



HEREDITARY INFLUENCES. 91 

not to be absolutely rejected. Wherever there is a 
doubt as to the interpretation of a candidate's history, 
as when pulmonary disease under another name 
appears rife in a family, the medical officer ought to 
give the company the benefit of the doubt, and re- 
commend increased rates or the rejection of the life. 
A great deal passes under the name of bronchitis 
and pneumonia and " child-birth," which is really 
tubercle ; the duration of the attack, and the accom- 
panying circumstances, will often aid in arriving at 
a correct conclusion. The existence of any symp- 
toms of phthisis, in a candidate whose family history 
is doubtful, makes a rejection of course imperative, 
but to this question we shall have occasion to refer 
more in detail later on. 

Authorities differ as to the frequency with which 
cancer is hereditary, but all are agreed as to the 
general fact. From the suffering it so frequently 
entails, it attracts perhaps even more attention than 
tubercular disease, but it is very much less frequent; 
for while, according to the latest Report of the Regis- 
trar-General for 1871, there are close upon 70,000 
deaths from tubecular disease in England, divided, 
almost equally between males and females, there are 
under 10,000 deaths from cancer, of which 6681 
occurred in females, and less than half that number, 
or 3060, in males. According to the Report of 1881, 
the numbers* were respectively in 1879, for tubercle 

*The relative proportions of the sexes remain nearly the same in 1879 as 
in 1871. The actual numbers are, for 

Tubercular Diseases . . 37,005 males, 33.390 females. 

Cancer .... 4,183 „ 8,616 ,, 



92 HEREDITARY INFLUENCES. 

70,395, and for cancer 12,789, showing an increased 
rate for the latter; "but how far," adds the Regis- 
trar-General, "this apparent increase is simply due 
to improved diagnosis, or how far to real augmenta- 
tion, is doubtful." Yelpeau was of opinion that 1 
in 3 cases of cancer showed a hereditary taint ; Sir 
James Paget's investigations yielded 1 in 4 ; Mr. 
Sibley concluded from the statistics of Middlesex 
Hospital that the proportion was nearly 1 in 12. 
Practically we cannot ignore the undoubted heredi- 
tariness of cancer, and as the female organs of repro- 
duction are specially liable to the disease, and we 
have seen that the female sex has an infinitely 
greater proclivity to cancer generally than the male 
sex, we must specially consider the influence of this 
hereditary taint where we have to deal with a female 
applicant for insurance. Cancer is a disease per $e, 
and is commonly found to exclude tubercle ; but 
undoubtedly the two may co-exist in the same indi- 
vidual ; * and where both occur in the same family, 
any member of it must be regarded as bearing a 
double risk, that should be proportionately taxed if 
he be at all admissible. 

Rheumatism is another form of disease, the 
tendency to which is hereditary in an undeniable 
manner. It is not so directly fatal as the maladies 
we have recently considered, but it contributes 
largely, in an indirect manner, by impairing vital 
power and damaging the heart, towards swelling the 

* See on this point some observations and cases given by Mr.Weeden Cooke 
in his work on Cancer, its Allies and Counterfeits. London, 1865, p. 11, and 
sqq. 



HEREDITARY INFLUENCES. 93 

lists of mortality. Dr. Fuller* found that of 246 
patients admitted into St. George's Hospital with 
acute rheumatism, 71, or 28*8 per cent, showed an 
hereditary predisposition to the disease from its 
having occurred in one or other parent. He is borne 
out in this view by the observations of Chomel, 
Macleod, and other physicians of eminence. 

Gout, again, which largely impairs life, is, like 
rheumatism, undoubtedly hereditary, and has long 
been recognised as possessing this character ; it is 
one of thoso heirlooms that people are even disposed 
to hoist of, on account of a certain air of respecta- 
bility that attaches to family gout. Here, thanks 
to the labours of Dr. Garrod, more than in any 
other so called blood-diseases, we have direct evi- 
dence of the existence of an abnormal constituent 
in the blood, leading us to hope that the same line 
of research to which Dr. Sanderson and other men 
of eminence in this country and abroad are devoting 
their attention may eventuate in a more ready 
recognition of the poison or anomaly that underlies 
most diathetic conditions. Dr. Garrod confirms the 
results arrived at by Sir C. Scudamore's analysis of 
522 cases, showing the hereditary influence to pre- 
vail in more than one-half. But the gouty diathesis 
exhibits itself in many patients in whom a bona fide 
attack of gout has never occurred, in degenerative 
conditions of the heart, blood-vessels, and secernent 
organs, as well as in the nervous system, which 

*On Rheumatism, etc., p. 32. 



94 HEREDITARY INFLUENCES. 

must not be lost sight of by a medical examiner for 
insurance. A great deal must be left to his individ- 
ual judgment and experience, as, although it is 
usual to take off three years from the expectation of 
life of a person who is shown to have had gout, we 
have not sufficiently precise data to estimate the 
hereditary influence in those who escape the regular 
paroxysm, but are found to possess indications of 
impaired vitality derived from gouty predecessors. 
The experience of the Equity and Law Life Insur- 
ance Society is to the effect that the usual addition 
of three years is by no means adequate, their data 
showing that the deaths from gout have been exces- 
sive, and that the excess has not been confined to 
any age. As the evidence is not easily accessible, 
the following table from the Equity and Law Report 
will be acceptable : — 



Deaths 


True 


Ages. 




Office Ages. 




under 












Age. 


Expected. 




Actual. 


Expected. Actual. 


40 


•60 




2 


•30 


1 


50 


3-43 




8 


2-37 


5 


60 


8-82 




12 


8-42 


8 


70 


12-63 




18 


1477 


14 


All Ages. 


13-4 




21 


16-15 


25 



Dr. Thompson gives some valuable remarks on 
the latency of gout, and the evidences which may 
guide us in its detection, both in children and adults, 
which we should be glad to reproduce, were we not 
afraid of exceeding our limits. 

The hereditary taint shows itself in a marked 
manner in the various diseases referable to the 
nerve-centres, but more in those which are connected 
with the brain than with the spinal cord. They 
are, however, with certain exceptions, chiefly the 



HEREDITARY INFLUENCES. 95 

appanage of advanced life, and do not affect life in- 
surance by any means in the same ratio as diseases 
of the thoracic and abdominal viscera. Thus apo- 
plexy is most common between 60 and TO. Dr. 
Begbie's* Analysis of the Mortality of the Scottish 
Widows' Fund for 30 years shows that of 72 cases 
20 deaths occurred before and 52 after the age of 
sixty, whereas among 72 cases of phthisis 36 deaths 
occurred between 30 and 40. The hereditary taint 
often shows itself in the reproduction of brain-dis- 
ease of a different form from that in which it appeared 
in the ancestors — a marked correlation existing be- 
tween apoplexy and its ally paralysis, epilepsy, hyste- 
ria, asthma, and insanity. Epilepsy, which unfortu- 
nately occurs most frequently in early life, exhibits in 
a marked form the hereditary impress, as well as this 
correlation; though, like most other diseases, it may 
arise spontaneously from purely idiopathic causes. 
Insanity, again, belongs to the morbid conditions in 
which the hereditary influence is strongly marked, 
though it does not appear largely to affect life in- 
surance business. Doctors Bucknill and Tuke f tell 
us that, though acute insanity shortens life mate- 
rially, the chronic form does not exibit that ten- 
dency. $ Di'- Wood even found that of 46 incurable 

* Monthly Journal of Medical Science, January, 1847. 

t A Manual of Psychological Medicine, by J. C. Bucknill, M.D., and D. A. 
Tuke, M.D. London, 1858, p. 268. 

X The Registrar- General gives us little help in this matter. In his Eeport 
for 1881 the number of deaths set down to insanity in all England in 1S79 are 
— males 732, females 831; but it may be taken as a fact that the majority of 
deaths of insane persons is registered under a different heading. The reader 
may read with interest a paper on the causes of insanity by Millingen, in his 
Curiosities of Medical Experience: London, 1839, p. 202. 



96 HEREDITARY INFLUENCES. 

patients at Bethlehem the average duration of life 
somewhat exceeded that of an equal number of lives 
among the sane of good health. Taking the statis- 
tics of insanity on an extended scale, however, there 
is no doubt that the general mortality of insane per- 
sons is larger than that of the sane ; for though it 
varies in the different asylums from 5*06 to 19*1 
per cent, even the lowest average is considerably 
above the general mortality of the population, 
which 5 in 1871, was 2*22 per cent. The hereditary 
influence is admitted by all writers on the subject, 
botli British and foreign ; and it is asserted that it 
is especially observed among those classes of the 
community, as among Jews and Quakers, who usually 
intermarry in their •own fraternity. It also appears 
that the hereditary taint is more frequently met 
with in the higher than in the lower classes,* as 
Esquirol,f for instance, met with 152 out of 264 
cases in his private practice, whereas Sir William 
Ellis J discovered an inherited influence only in 214 
cases out of 1380, at the Middlesex Pauper Lunatic 
Asylum. 

Many speculative questions suggest themselves 
with reference to inherited influences beyond what 
has been alluded to. But our wish is to keep as 
much as possible on the patli of established or 
approximately established fact ; and therefore we 

* This may be partly attributable to the greater strain on 
the mind to which numbers of the upper classes of society 
are subjected, in which the high pressure of modern life has 
a tendency to foster brain-disorders of all kinds. 

t Dictionnaire cles Sciences Mtdicales, tomes xvi. and xxx. 

J Reports of Hanwell, 1839. 



HEREDITARY INFLUENCES. 97' 

avoid mere hypothesis, which should, though not 
altogether to be set aside, be as little as possible 
countenanced in matters of life insurance. There 
is not an organ or part of the body in which pecu- 
liarities of function or tissue are not frequently 
traceable in the ascending or descending line ; and 
it is always well for the medical man to bear in 
mind this general law of transmissibility, and to 
estimate the special bearing of any recurrent devia- 
tion from the normal condition. Heart-disease, 
disease of the chylopoietic viscera, as shown in 
various forms of dyspepsia, and especially in diabe- 
tes, renal affections, and diseases of the veins, are 
among those disorders for which the practitioner not 
unfrequently discovers an hereditary origin. But we 
do not possess sufficiently precise data to put statisti- 
cal proofs of the frequency of this predisposition 
before our readers, and must be content with the 
general indication, leaving to each medical man the 
application to every individual instance. 

We have alluded above to the possibility of ob- 
taining information on the subject of hereditary 
transmission by arguing back from the children to 
their parents. If it be true that healthy parents 
bring forth healthy children, it appears to follow 
that an unhealthy progeny argues a vitiated stock. 
And so it certainly does ; but this element, though 
of much importance to the political economist or 
anthropologist, is only of minor consideration to the 
insurance physician, because the great majority of 
persons who insure their lives do so either before 
they have a family or when it is rather in posse than. 



98 



HEREDITARY INFLUENCES. 



in esse. We would, however, take this opportunity 
of entering our protest against the prevailing habit 
of treating the deaths of young children too much 
as a matter of course, either as an inscrutable act of 
Providence, or as a providential arrangement to 
prevent over-population. We believe neither in the 
necessity of premature death nor of disease ; and 
though neglect and ignorance of natural laws that 
rule the training of the infant bear a large share in 
the mortality of young children, we dare not shut 
our eyes to the fact that premature decay is very 
often the result of a taint imparted to them by their 
parents ; when this is capable of satisfactory proof 
it is manifest that, according to its specific character, 
it must reduce, to employ life insurance phraseology, 
the value of the lives of the latter. 



CHAPTER V. 

THE HISTORY OF THE INDIVIDUAL. 

We now proceed to examine those points in the 
personal history of the candidate for insurance which 
are to guide us in forming an opinion as to his eligi- 
bility, in gauging the deteriorating influences to 
which he may have been subjected, or in advising the 
company to reject the life altogether as uninsurable. 
The medical officer has a responsible duty to perform. 
Two parties are both desirous of entering into a con- 
tract, and he is eventually the person who determines 
the basis of the contract. The company is desirous, 
on the one hand, of doing business ; but if it is well 
conducted, it does not wish to risk its stability by 
laxity in selecting the lives, or to incur the imputa- 
tion of too great and unreasonable severity in reject- 
ing them on inadequate grounds. On the other 
hand, the person who has made up his mind to take 
out a policy, has a right to fair treatment, as an un- 
necessary increase of premium touches his pocket 
at once, and rejection not only prevents his making 
the desired provision for his family at one office, but 
renders him, owing to the mutual understanding that 
exists between all first-class offices, less liable to be 
accepted elsewhere ; besides seriously affecting his 
morale, by informing him that he has small chance of 
attaining to the average term of life, of which he 
may have had no previous suspicion. If he is sufficient- 



100 THE HISTOUY OF THE INDIVIDUAL. 

ly trained for his work, and performs his task without 
fear or favour, the medical officer, like any man who 
does his duty, may act without fear of consequences; 
but incapacity or hasty judgment will certainly before 
long recoil upon him in this relation as in every other. 

The general aspect of the examinee is probably 
the first point that will attract the examiner's atten- 
tion ; who will notice the gait, the manner, the 
speech, the complexion ; and bear in mind any pecu- 
liarity that may be an indication of previous habits, 
for comparison with the applicant's statements. If 
the first impression is ever so favourable, the appli- 
cant's age corresponds with his appearance, and no 
flaw is to be detected in the reports of his friends or 
in his own statement, a personal inquiry into the 
different points bearing upon the duration of life still 
is necessary ; because, without an intentional fraud, 
there will be a natural bias to adopt a favourable inter- 
pretation, and a fair exterior may hide internal mis- 
chief; just as accidental circumstances may mislead 
the examiner into the belief in a morbid taint, where 
a careful examination fails to detect anything of 
the kind. 

We have already shown that occupation has a 
marked bearing on longevity, an hereditary or 
personal defect, that may merit no attention under 
certain circumstances, may become the subject of 
grave suspicion in others. An occasional attack of 
simple catarrh or bronchitis would not justify an in- 
creased rate in a professional man or a merchant ; 
whereas in the baker, who is exposed to great vicis- 
situdes of temperature, to the inhalation of flour and 



THE HISTORY OF THE INDIVIDUAL. 101 

dust, and who is deprived of the normal allowance of 
sleep, the danger of the affection merging into con- 
sumption, or other serious lung disease, would operate 
very differently. A commercial traveller is exposed 
to the double risk entailed by constant railway travel- 
ling, and to social claims that exist among his frater- 
nity, which is necessarily increased if his particular 
specialty requires him to be on intimate terms with the 
bar, and he has to recommend the produce of fermen- 
tation and distillation. Continuous railway travelling, 
apart from the direct injury resulting from accidents, 
is prejudicial in various ways ; and many persons who 
reside at a distance from their place of business, in 
order to benefit by country or sea air, neutralise these 
advantages by the wear and tear to body and mind 
incidental to daily railway journeys, even if the dis- 
tance is not considerable.* Many is the time when, 
on medical grounds, we have seen reason to discoun- 
tenance such an arrangement ; and where, as in 
underground railways, the passenger, during his tran- 
sit from the breakfast-table to a dingy office, or back 
again, is further deprived of the influence of fresh 
air and exercise morning and evening, which he might 
have by walking or driving the same distance, with 
more distraction, the objection becomes still greater. 
From the involuntary efforts constantly made during 
the quick transit to preserve the equilibrium of the 
body, a peculiar burden is laid upon the muscular 
system, while the constant succussion that the body 
is subjected to overtaxes the nervous system, and is 

* See on the subject of railway travelling, The Lancet, Jan. 
11, 18G2. 



102 



THE HISTORY OF THE INDIVIDUAL. 



conducive to paralytic affections ; again, the rapid 
succession of objects, the noises, the necessity for be- 
ing constantly on the alert, affects the brain through 
the eye and the ear, while it excites both the respi- 
ratory and circulatory systems. It is found that 
members of the post-office staff are frequently inca- 
pacitated from acting in the travelling service by the 
prejudicial influence of railway locomotion, and that 
" bilious" persons are particularly unsuited for that 
kind of work. In no way can railway travelling be 
regarded as conducive to health ; and if we have to 
deal with a person who cannot avoid spending much 
of his time in trains, this may influence the rate to 
be demanded, especially if any suspicion of brain- 
disease, or a tendency to it, already exists. 

The following table, which we extract from the 
Lancet, and which shows the number of days during 
which the members of each class are laid up by 
sickness, exhibits strikingly the influence of railway 
travelling upon health : — 



Age. 


England and 

Wales 

at large. 


Heavy Labor. 


Mariners. 


Railway 
Officials. 


Without 
Exposure. 


With 
Exposure. 


20 
25 
30 
35 
40 
45 
50 
60 


26-62 
23-94 
22-57 

22-38 
23-26 
24-11 
26-00 
31-07 


26-47 
25-10 
23-45 
24-00 
24-34 
25-14 
28-10 
33-25 


28-69 
26-47 
25-74 
25-64 
27-01 
28*14 
29-34 
35-42 


16-89 ■ 
15-61 

17-96 
18-86 
17-89 
20-51 

22-27 
28-00 


31-00 
38-06 
33-94 
34-11 
32.23 
32-10 
30-43 
41-76 



THE HISTORY OP THE INDIVIDUAL. 103 

Among the dangerous trades are to be classed 
those which are exposed to the inhalation of dust. 
This is one of the causes inducing a large mortality 
among bakers, miners, and cotton operatives, but 
especially among the steel- grinders of Sheffield. Dr. 
Holland of that town has especially drawn attention 
to the causes of the maladies from which they suffer 
and the circumstances under which they work. The 
grinders' asthma, which has-been traced to the inha- 
lation of particles of steel, gives rise to irritation of 
the pulmonary tissues, inducing a form of consump- 
tion of the most intractable nature, so that few of 
this class of operatives survive the age of 35. 
Other influences are also undoubtedly at work to 
cause this high rate ol mortality ; but as the Sheffield 
grinder rarely becomes a candidate for life insurance, 
we need not dwell upon his habits in this place. The 
same applies to the working stone mason, who, owing 
to the inhalation of stone dust, suffers similarly, 
though in a minor degree. The fact of his opera- 
tions being conducted more in the open air is in his 
favour ; and this leads us to remark generally of all 
trades, that the more they involve confinement in a 
close atmosphere, a cramped posture, and a tempta- 
tion to drink, the greater the liability to receive or 
develop any taint to which they are exposed. It is 
rare that we have to deal with one element only in 
the causation of disease. 

Thus the printer presents a very unfavourable 
mortality, owing to the ill-ventilated, small, over- 
crowded apartments, often only lit with gas, in which 
he works. The depression thus induced leads to a 



104 THE HISTORY OF THE INDIVIDUAL. 

large consumption of alcoholic beverages, which fur- 
ther charge his blood with deleterious compounds, 
and the handling of the types, composed of anti- 
mony and lead, induces the direct poisoning that 
leads to paralytic and convulsive diseases. 

Here, as in most trades, improvements are con- 
stantly being effected, and it is not too much to hope 
that as sanitary science becomes more and more dif- 
fused, the progress that has already taken place will 
eventuate in removing all those causes of excessive 
mortality which have been recognised and are under 
the control of man. 

The trade of the painter and plumber, from their 
being subjected to the influence of salts of lead, often 
gives rise to paralytic conditions, and to impaired 
nutrition of the heart, and induces a proclivity to 
gout.* This is due to the absorption of lead! into 
the system, which may be guarded against by using 
certain precautions, of which cleanliness is the chief; 
but it is found that an undue proportion of deaths 
also occur in these trades from accident. The classes 
of men that are worst off in this respect are seamen, 
miners, and engine ^drivers, for whom it is the com- 

* GaiTod on Gout, p. 282. See also, at p. 284, Dr. 
Christisoms remarkable statement as to the immunity of the 
printers in Edinburgh, and the reasons assigned by him. 

fThe general population also frequently present instances 
of lead-poisoning through the introduction of the salts of the 
metal by the lungs or the stomach. Thus it has occurred 
through wine sweetened by litharge, water that has dissolved 
a salt of lead when contained in leaden pipes or cisterns, cider, 
rum, and sugar impregnated with the deleterious metal. Snuff 
has repeatedly been known to cause serious and even fatal 
effects from being adulterated with salts of lead. 



THE HISTORY OF THE INDIVIDUAL. 105 

mon practice to charge a special rate on account of 
the risk their occupation brings with it, amounting 
to from 15s. to 40s. per cent on the average pre- 
mium for healthy lives. The extra rate for mariners 
is generally 25s. per cent per annum, that for miners 
20s; 3 and a little less for mining engineers and agents. 
Mr. Harben* gives their relative mortality from 
accident as follows : — 

Seamen . 35 per cent. 

Miners and quarrymen . , . . 25 ,, „ 

Engine attendants 15 „ ,, 

Painters, plumbers, and glaziers . . . 10 „ „ 

We may quote from the same authority one or two other 
facts connected with the question of violent deaths, 
for which we should scarcely have been prepared. 
Mr. Harben tells us that more deaths from violence 
occur in males from 10 to 19 years than at any other 
age ; that from 20 to 39 more married men die from 
that cause than bachelors ; but that at 40 years a.nd 
upwards, single males and females die in greater pro- 
portion from violence than those who have entered into 
a matrimonial partnership. These statistics suggest 
some curious psychological and physiological prob- 
lems, which, however, this is not the place to discuss. 
We have already seen that the highest rate of mor- 
tality is found among inn and beer-shop keepers. 
It is difficult to determine why in civil life butchers 
rank next to them, because their occupation is not 
in itself to be considered unhealthy, nor one ordi- 
narily entailing much anxiety. In both, probably, 

* Mortality Experience of the Prudential Assurance Com- 
pany, by Henry Harben. London, 1871. 



106 THE HISTORY OF THE INDIVIDUAL. 

the danger arises from the temptations they are sub- 
jected to of indulging in habitual dram-drinking. 
The publican is constantly surrounded by an atmos- 
phere of alcohol ; and few of his class escape the 
train of symptoms indicating successively disorder 
of the stomach, the liver, the kidneys, and the brain, 
which this insidious poison excites and fosters with 
fatal pertinacity. 

The practice of insurance companies with regard 
to publicans varies ; some, we believe, exclude them 
altogether. This we regard as harsh and unneces- 
sary, and scarcely compatible with the philanthropic 
spirit which underlies insurance business. On the 
other hand, we consider the ordinary addition of 10 
per cent as far too low for this very hazardous trade, 
and should consider five-and-twenty per cent more 
in accordance with what is just, until the devoutly- 
to-be-wished-for consummation of a marked improve- 
ment in the vital statistics of publicans can be de- 
monstrated. 

But, unfortunately, in all classes of the community 
the abuse of alcoholic beverages prevails to a large 
extent,* and the inquiry into the amount taken by 
the individual is always fraught with difficulty. The 
spirit-drinkers of every class are liable to suspicion, 
but wherever it is elicited that ardent spirits in any 
form are habitually or frequently taken during the 

* Mr. Neison's calculations give — 
1 drunkard to every 74 of the male population. 
1 „ „ 434 of the female population. 

1 ,, „ 145 of both sexes above the age of 20. 

We fear that more recent investigations show even a larger 
proportion. 



THE HISTORY OF THE INDIVIDUAL. 



107 



day, the suspicion amounts to a certainty that the 
life, in insurance parlance, may be considered as a 
damaged one. 

Mr. Neison,* in a very elaborate paper on the 
rate of mortality among persons of intemperate 
habits, shows that the expectation of life of intem- 
perate persons is much below the average ; and that 
an intemperate person of 20 has reduced the average 
expectation from 44*2 years to 15*6 ; a person of 
30, from 36*5 to 13*8 years ; a person at. the age of 
40, from 28*8 to 11*6 years; and also that while 
diseases of the nervous system and digestive organs 
give rise to 15*9 per cent of deaths in the popula- 
tion at large, they form 50*40 per cent of all deaths 
among the intemperate. 

Intemperance reduces the expectation of life more 
in the upper classes than among mechanics and 
tradesmen. 

Mr. Neison finds that from the age of 16 upwards 
the relative mortality of intemperate persons exceeds 
that of the general population of England 3*25 times. 
At the term of life 21 to 30 the mortality is upwards 
of five times that of the general community, and in 
the succeeding 20 years of life it is above four 
times greater. He offers the consolatory remark 
that the drinking practices of society have improved 
during the last quarter of a century, and that what 
(in 1851) was commonly regarded as free living, 

* Journal of the Statistical Society, Sept. 1851, vol. xiv. A 
valuable paper on the same subject is also published by Mr. 
Scratchley in his Contributions to Vital Statistic? : London, 
1857, p. 201. 



108 



THE HISTORY OF THE INDIVIDUAL. 



would some years since only have been regarded as 
moderation. " In like manner," he adds, " it may be 
hoped that the usages of society will continue io 
improve ; and, at no distant date, the habits now 
considered not to exceed the bounds of moderation 
be altogether unknown in polite and refined society." 
The following table, taken from Mr. Neison's 
essay, exhibits in a striking manner the relative 
mortality of intemperate and temperate individuals, 
and justifies the startling conclusions arrived at by 
Mr. Neison, while it shows the special proclivity of 
certain organs to suffer under the pernicious influ- 
ence of alcoholic beverages :^— 

Ratio pee cent of Deaths at ages 20 and upward from 
different causes, to the total deaths from all 
causes at the corresponding ages in the general 
community. 



Causes of Death. 


England and 
Wales 1847. 


Gotha Life 
Office. 


Scottish 

Widows' 

Fund. 


Intemperate 

Lives. 


Head Diseases . 
Digestive Organs 
Respiratory . . 

Total .... 


9-710 

6-240 

33-150 


15-176 

8-377 
27-843 


20-720 
11-994 
23-676 


27-10 
23-30 

22-98 


49-100 


51-396 


56-390 


73-38 



This table indicates the true bearing of intemperance, 
not so much in being itself the immediate cause of 
death as in its increasing the fatality of other dis- 
ease ; were this not the case, the small number of 
deaths set down to alcoholism and delirium tremens 



THE HISTORY OF THE INDIVIDUAL. 109 

combined (for both sexes it amounted in 1G71 only 
to 740) would scarcely attract attention, and the 
subject would not merit all the space we have be- 
stowed upon it. The freedom from intoxication and 
the baneful effects of chronic alcoholism in countries 
where the primary products of fermentation of grape 
juice are used by the population, and our experience 
in our own country to the same purport,* makes it 
impossible for the medical man to condemn the 
moderate use of wine, and we equally question whe- 
ther deleterious effects can ordinarily be traced to 
unadulterated malt liquors. Even where abuse can 
be shown, this would be as little an argument in 
favour of general teetotalism as if some one were to 
assert that, because the greater part of London, Ham- 
burg, and Chicago were destroyed by fire, we were to be 
debarred the use of fire to cook our meals. Though 
we highly honour those who, from conscientious mo- 
tives and for the supposed good of their fellows, take 
the pledge of total abstinence from all fermented 
liquors, we think that a higher morality, as well as 
better knowledge, displays itself in avoiding their 
baneful abuse and encouraging their wholesome em- 
ployment. Unfortunately for the cause of teetotalism, 
its advocates have scarcely as yet given satisfactory 
proof that their system possesses all the advantages 
they claim for it. Mr. Scratchley,f after exhibiting 

* The special injury resulting from ardent spirits, as com- 
pared with the produce of the primary fermentation of the 
grape and of malt, is also shown in the statistical paper of Mr, 
Neison just quoted. 

t Contributions to Vital Statistics, p. 218. 



110 THE HISTORY OF THE INDIVIDUAL. 

the striking effects which intemperance exerts upon 
longevity, goes on to remark — " It would be curious 
to contrast with the above results the rate of mor- 
tality among persons who have been for a consider- 
able period of years, or for the whole of life, ab- 
stainers from intoxicating drinks ; but, unfortunately, 
there are no available data connected with this cip,ss 
of lives, and it seems there will long be considerable 
difficulty in procuring such information. A few 
years ago Mr. Munro of Enfield, at much trouble 
and expense, procured returns from Rechabite so- 
cieties, showing the rate of mortality and sickness 
experienced by the members ; and it is known that 
the results, although not published, exhibit as high 
a rate of mortality and sickness as is found to prevail 
among the members of other friendly societies. The 
facts collected by Mr. Munro are of great value, and 
it is to be regretted that the societies furnishing 
them should, on account of the unfavourable nature 
of the results arrived at, object to their publication." 
Mr. Scratchley seeks to offer the Rechabites a little 
comfort under these unfavourable circumstances, for 
he goes on to say that " although they show a high 
rate of mortality, it should be kept in view that all 
the members cannot be considered as the. type of 
total abstainers, many of them being reformed 
drunkards, and, as such, have become teetotallers 
with broken-down constitutions." The author, 
therefore, infers that " until Rechabite societies have 
enrolled a class of members who have been abstainers 
from infancy, they cannot expect an entire immunity 
from those diseases and deteriorating influences to 



THE HISTORY OF THE INDIVIDUAL. Ill 

which less careful members of the community are 
subject." It is, however, only fair to state that since 
this was written, Mr. Samuel Brown has stated that 
the temperance section of the Temperance Provident 
Life Office exhibited a lower rate of mortality than 
the general section. Milton anticipated this contro- 
versy, and concentrated* the pith of the matter in 
the following exquisite lines : — 

" If all the world 
Should, in a fit of temp'rance, feed on pulse, 
Drink the clear stream, and nothing wear but frieze, 
Th' Allgiver would be unthaiuVd, would be unprais'd, 
Not half his riches known, and yet despis'd." 

In the present state of society it is, unfortunately, 
not only a question of quantity which determines 
the hurtful or harmless effect of alcoholic liquors, 
but we are surrounded by dangers, owing to the 
clever adulterations which are palmed upon us as 
genuine articles. Here science and the sanitary 
medical officer must be called in to protect us. As 
milk, the mildest and most wholesome of all beve- 
rages, may bring death and misery into families 
through the iniquity of the dairyman, so adulteration 
may render the most wholesome alcoholic beverages 
unfit for human consumption. The caveat-emptor 
principle is scarcely applicable, because the purchaser 
can have neither the knowledge nor the means of 
testing every glass that he drinks, and his taste is 
often so perverted that he learns to prefer th^ 
poisonous compounds to the healthy produce. It 
is here that legislative enactments are absolutely 
required of the most stringent character to prevent 



112 THE HISTORY OF THE INDIVIDUAL. 

fraud, and to protect those who are unable to protect 
themselves. 

We need not again dwell upon the value of pro- 
fessional lives, because we have already shown that 
they exhibit the highest averages. They are a practi- 
cal illustration of the ancient saying, "in medio tutissi- 
mus ibis." We have al^T) briefly adverted to the 
generally low average presented by crowned heads, 
which is of importance in regard to life insurance, 
not because they individually apply to be insured, 
but because, unknown to themselves, various life in- 
surance contingencies are made to depend upon their 
lives. We are therefore tempted to say a few more 
words on the subject. The duration of life among 
the upper classes, according to Dr. Guy,* whose 
general conclusion agrees with those of Hufeland 
and Caspar on this point, varies inversely with 
their rank. Beginning with the class which has the 
shortest average duration of life, the several classes 
are found to stand in the following order : — 

1. Sovereigns. 2. Male members of royal houses. 
3. Female members of royal houses. 4. Peers, being 
successors to the title. 5. Male members of the peer- 
age and baronetage. 6. Male members of the gentry. 
7. Professional men. 8. Females of the upper 
classes. Hufeland tells us, that in the whole cata- 
logue of Roman and German emperors, from Augus- 
tus downwards, amounting to 200, only four — Gordian, 
Valerius, Anastasius, and Justinian — attained the 
age of 80 ; while of 300 popes, only five readied 
that age. It appears, further, that in Germany the 
* Journal of Statistical Society, vol. ix., 1846. 



THE HISTORY OF THE INDIVIDUAL. 



113 



reigns of 38 emperors lasted on an average 19 years ; 
in Sweden, 44 kings reigned 18 years each, in 
Russia 50 czars reigned on an average 15 years, 
while in our own country, bad as things have been, 
the average has been 22-§- years.* A very elaborate 
article on the Duration of Life of Sovereigns is pub- 
lished by Dr. Guy in the tenth volume of the Jour- 
nal of the Statistical Society, where the reader will 
find a variety of interesting information, the main 
inference from which is, that " whether we form an 
average from a large number of facts gleaned from a 
wide field of observation, or split up this single group 
into the smaller elements of which it consists, we 
arrive at the same conclusion, that sovereigns, as a 
class, are among the shortest-lived of human beings. 5 ' 
In order to give further support to this statement, as 
well as on account of the general value of the table 
in reference to vital statistics, we extract from the 
same article the following figures, which Dr. Guy has 
compiled partly from his own researches and partly 
from those of Mr. Neison. 



Agricultural Laborers (Benefit Societies) 
Rural Districts do. 

Town Districts do. 

England (whole population) 
Professions (chiefly clergy) 
Assured Lives (Amicable) . 
City Districts (Benefit Societies) 
English Gentry 



Expectation 
of life at 30. 

40-6 
38-4 
34-6 
34-1 
339 
337 
32'9 
31-2 



* Quoted by Walford, p. 67, from Dr. Fan* in M'Culloch's 
British Empire. 



114 



THE HISTORY OF THE INDIVIDUAL. 





Expectation 




oflifeat30. 


English Aristocracy 


30-9 


Clerks (Benefit Societies) . 


30-5 


Liverpool do. 


301 


Dundee (whole population) 


291 


Northampton Table (Price) 


28-3, 


Sovereigns 


273 


Liverpool (whole population) 


27*0 


Glasgow do. 


24-9 



Our own Palmerston, and the distinguished states- 
man who has recently vacated the Presidential chair 
in France, are marked exceptions to the rule, that 
their order has the melancholy prerogative of falling 
early victims to the duties of their calling. The 
average duration of life of statesmen is only 56 years, 
while that of the professional classes is over 73. 



Age. 


Number of Deaths. 


Per cent. 


Roy. Houses 


>> 

03 

3 

o 

Xfl 

< 

60 


O 
105 


t£ 

o 

a> a? 

fe ft 
ft 


Royal Houses. 


3 
o 

Cfi 




o 

S3 

a> a) 

En ft 

ft 


Males 


Fe- 
males 


Males. 


Fe- 
males. 


21-30 


5 


3 


150 


4-90 


5-00 


4-85 


5-87 


7-86 


31-40 


4 


7 


65 


83 


146 


3-90 


11-67 


5-26 


4-64 


7-66 


41-50 


13 


5 


109 


110 


133 


12-74 


8-33 


8-80 


6-15 


6-97 


51-60 


25 


11 


183 


177 


144 


24-52 


18-33 


14-76 


9-90 


7-55 


61-70 


18 


14 


252 


386 


290 


17-65 


23-34 


20-34 


21-60 15-21 


71-80 


26 


15 


331 


500 


474 


25-51 


25-00 


26-71 


27-98,24-86 


81-90 


10 


4 


216 


336 


422 


9-80 


6-67 


17-43 


18-79 22-13 


91-100 


1 


1 


23 


90 


118 


0-96 


1-67 


1-85 


5-07 


7-76 


and upwards 























The preceding table, given by Dr. Guy, affords a 
clearer survey of the mortality of the upper classes 
of this country than any paraphrastic statement that 



THE HISTORY OF THE INDIVIDUAL. 115 

we could put before them ; the numbers and percent- 
age proportions are arranged in periods of 10 years.* 

It is, however, only right to state, that Messrs. 
Bailey and Day question the correctness of the facts 
upon which Dr. Guy bases his calculations regarding 
the peerage, and their researches lead them to different 
results. They state that the average mean duration 
of male lives among the families of the peerage is, at 
all ages under 73, greater than that of the general 
population of the country, greater even than among 
the selected lives of the Equitable Society (with the 
unimportant exception of the period from 15 to 21), 
greater at all ages under 62 than among the Govern- 
ment annuitants, and throughout, approaches to the 
standard mortality of the healthy districts. With 
regard to female lives, these authors find that the 
mean duration in the peerage is throughout materi- 
ally greater than with the general population, indi- 
cating a more favourable mortality at the older ages 
than any table with which they are acquainted. As 
with the males, there is a marked contrast with the 
general population under the age of 10 ; in the next 
decade the females show an excess in the mortality, 
as the male lives do during the third decennial period. 

After the summary of the work of the session, 
1860-61, given in the Report of the Council of the 
Institute of Actuaries, it is stated that Mr. Jellicoe, 
the president, expressed a strong opinion that Messrs. 

* Journal of Statistical Society, 1846, p. 45. The table 
is compiled from the obituaries of the Annual Register from 
the date of its first publication in 1758 to the year 1843 in- 
clusive. 



116 THE HISTORY OF THE INDIVIDUAL. 

Bailey and Day * have proved their case. We must 
leave it to the judgment of our readers to determine 
which authority they will accept for their guide in 
this matter. 

Officers of the army present no special feature as 
regards life insurance, and are only called upon to 
pay extra rates when they are on duty entailing the 
contingencies of war, or when they are sent to sta- 
tions in tropical regions. These rates vary according 
to the circumstances of the case. Thus, in the 
Crimean War the rate at first was from 5 to 10 
guineas per cent per annum extra, but as the war 
continued the rate became more severe. During the 
Abyssinian expedition the addition was 5 guineas 
extra for not more than a year. During the war of 
1866 the German -offices appear to have charged an 
extra rate of 4 guineas ; but during the last war be- 
tween France and Germany 10 guineas was charged 
for six months for combatant officers, and 10 guineas 
per annum for medical officers. In India the rate of 
2 per cent extra covers death from all causes there. 

The officers of H.M. Navy are required to pay 
the usual rates, with 10s. 6d. per annum within the 
limits, but a special rate beyond the limits. These 
limits vary even now at different offices, but there is 
a general tendency to expand them ; but, of course, in 
case of war, naval officers are mulcted in a higher 

* On the Rate of Mortality among the Families of the 
Peerage, by A. H. Bailey, actuary of the Equity and Law 
Assurance Societies and Fellow of the Institute of Actuaries ; 
and Archibald Day, Actuary of the London and Law Assur- 
ance Society and Fellow of the Institute of Actuaries 
(Assurance Magazine, July 1871). 



THE HISTORY OF THE INDIVIDUAL. 117 

rate, like that imposed on officers of the army, to 
meet the special risk. 

Mr. Bailey,* in an article on the rates of extra 
premium, tells us that in 1741 extra premiums were 
charged for a voyage to 

• Flanders and back . . £16 per cent. 

Ireland and back . . 10 „ 

Scarborough by sea . . 10 „ 

Gibraltar . . . 2 2 0,, 

(And the same as late as 1821.) 
Holland, Germany, and Russia 10 „ 

Even now several offices restrict the lives assured to 
Europe ; but, excepting a small extra charge to cover 
the extra risk of the voyage out and home, most 
offices include within the limits of the ordinary rate 
the Azores, Madeira, British North America, and the 
United States east of the Mississippi and not south 
of the latitude of Washington, or such parts of South 
America, the Cape of Good Hope, and Australasia, 
including New Zealand, as are south of 30 degrees 
of south latitude. 

Thanks to the increasing influence exercised by the 
medical profession, many of the dangers which for- 
merly beset the military and naval man have been 
removed or diminished. We have already shown 
how greatly the expectation of life in the common 
soldier has been improved within the last twenty 
years. In Her Majesty's Navy the fell disease 
scurvy, which formerly more than decimated it, is 
no longer known, and improved ventilation has done 
much to increase the wholesomeness of our ships of 
war. The actual horrors of war, and the consecutive 
* Assurance Magazine, vol. xv. p. 78. 



118 THE HISTORY OF THE INDIVIDUAL. 

effects upon the combatants, have been much dimin- 
ished by the Red Cross Society and the humane 
tendencies of the age, though there is little hope of 
realising the dream of Henry IV. of France and 
many well-meaning persons of all ages, of establish- 
ing universal peace. 

In regard to life insurance, it is satisfactory to 
know that there is here, as elsewhere, an improve- 
ment in the prospect of life, and it may be well to 
take the present occasion of bringing before the 
reader a little further evidence of the real improve- 
ment in sanitary matters, as shown by the influence 
of modern civilisation upon longevity. A reduction 
of the rates of insurance has already resulted from 
the amelioration that has been demonstrated, and it 
is reasonable to assume that a further reduction,* 
compatible with safety, and therefore beneficial 
equally to insurer and insuree w T ill be effected. 

Scurvy, dysentery, ague, may in England be re- 

* There are two sides to every question ; we therefore quote 
the remarks which Mr. Griffiths Davies makes on this point. 
" The diminution of mortality has been urged to favour 
the reduction of the rates for life assurances ; but granting 
that, with the improvement of medical science, and the suc- 
cessful extermination of several diseases by which our prede- 
cessors have suffered, connected with increased knowledge and 
more comfortable means of subsistence, as well as improved 
habits, greater degree of cleanliness, ventilation, etc., the rate 
of mortality to have been considerably reduced, it fol- 
lows that the very fact of its being variable, must strengthen 
the idea of the possibility of its again increasing with other 
changes of circumstances, which may take place before a con- 
siderable proportion of the risk now undertaken by insurance 
companies shall have been discharged." — (Treatise on Annui- 
ties, }). 14.) 



THE HISTORY OF THE INDIVIDUAL. 119 

garded as enemies of no account, when we consider 
their former ravages; while syphilis, gout, scrofula, 
and its congeners, have abated much of their severity 
under the wiser measures that we now employ to 
counteract them. «* 

If we look to the history of scurvy, we find that it 
was formerly very prevalent on shore, owing to the 
absence of vegetables, and even as late as the 17th 
century, annually from 50 to 90 deaths took place in 
London alone from this disease. At sea the mortality 
resulting from it was frightful ; thus in 1726, Admi- 
ral Hosier sailed to the West Indies with seven ships, 
and buried his ship's company twice, when heJiim- 
self died, worn out by chagrin. In 1741 Lord 
Anson lost half his crew in six months from scurvy ; 
at the end of the second year of his voyage only 71, 
out of 961 men wlio sailed with him, w r ere fit for the 
least duty. The introduction of lemon juice as a 
part of a sailor's rations at the beginning of the pres- 
ent century — thanks to Dr. Lind, Sir Gilbert Blane, 
and others — had so good an effect, that whereas be- 
fore its use in 1780 there were 1457 cases of scurvy 
in Haslar Hospital, within eighteen months of its 
employment there was not one. In connection with 
this matter, we may again advert to the advantage of 
good light wine over ardent spirits, which are still 
too much resorted to in our navy. For when, during 
the blockade of the River Plate in 1845, by the 
French and British squadrons, the latter suffered 
much from scurvy, which the former escaped, owing 
mainly, as Dr. feryson lias shown, to their daily 
ration of red wine, while the English sailors had 



120 



THE HISTORY OF THE INDIVIDUAL. 



their usual allowance of rum. Sir Gilbert Blane 
founded a gold medal, to be awarded biennially to 
medical officers of the navy for meritorious contri- 
butions to the literature of their profession ; and 
there has been no worthier recipient of the honour 
than the medical officer of the Investigator,* Dr., 
now Sir Alexander Armstrong, who carried his ship's 
crew through unparalleled hardships, but with un- 
paralleled success, and with comparative immunity 
from scurvy, under circumstances of great privation, 
during Captain Maclure's search after the North-west 
Passage. Unfortunately the merchant service has 
greatly neglected the rules laid down for the preven- 
tion of scurvy, as recent discussions in the journals 
have demonstrated. So late as 1852 to 1857 inclu- 
sive, there were 172 deaths from scurvy in British 
foreign-going ships, distributed as shown in the fol- 
lowing table,f obtained from the log-books and other 
documents in the office of Captain Hoskins, E.N., 
Registrar-General of Seamen : — < 



Years. 


Vessels. 


Tonnage. 


Crews, 

exclusive of 

Masters. 


Total 
Deaths. 


Deaths 

from 
Scurvy. 


1852 


7580 


2,449,364 


110,769 


2298 


17 


1853 


8357 


2,791,224 


122,091 


3263 


10 


1854 


7418 


2,759,120 


114,639 


2799 


35 


1855 


7957 


3,018,951 


123,733 


3292 


50 


1856 


8551 


3,190,011 


127,805 


3606 


32 


1857 


8100 


3,168,105 


124,580 


3474 


28 



* Observations on Naval Hygiene and Scurvy. By Alex- 
ander Armstrong, M.D., R.N. London, 1858. 

t British and Foreign Medical Chirurgical Review, October 
1858, p. 397. 



THE HISTORY OF THE INDIVIDUAL. 121 

Another disease with which, in England, we are 
now only acquainted in its milder forms, but which 
formerly was a cause of great mortality in this 
country, is dysentery or bloody flux. Sydenham,* 
who lived in the middle of the ITtli century, speaks 
of it as a common disease affecting a large number 
of people, and the bills of mortality show it to have 
been one of the most fatal diseases. The annual 
mortality from 1667-1692 amounted in London to 
2000 per annum from this disease. f What the mor- 
tality throughout England was, we have as little 
means of showing as we can give that formerly pro- 
duced by ague, which Dr. Caius states to have been 
so fatal in London in the year 1558, that the living 
could hardly bury the dead. The real nature and 
cure were so little understood that it even came to 
be looked upon as rather a beneficial influence, which 
kept off other diseases, so as to give rise to the adage 

that 

" An ague in spring 
Is fit for a king." 

Without speculating upon this view of the matter, 
we may remind the reader that James I., and after- 
wards Cromwell, fell victims to ague. The plague 
and black death, which are probably synonymous, 
have been entirely banished from these realms, as 
well as a dirie disease known as the sweating sick- 
ness; but without pursuing this important matter 
further, we limit ourselves to giving a few data ap- 

* Medical Observations, chap. 3. 

t Heberden on the Increase and Decrease of different Dis- 
eases in London. 1801. 



122 THE HISTORY OF THE INDIVIDUAL. 

plicable to more recent times. The effects of small- 
pox, which at one time destroyed half our population, 
have now been reduced to small proportions, though 
even recent legislation has not put this country — ■ 
where vaccination was first discovered — on a par 
with Continental States in which the process has 
been more thoroughly and carefully carried out. 

In the half century from 1750-1800 the deaths 
from smallpox in England for every 1000 
deaths amounted to . . . 96* 

From 1800 to 1850 the deaths from small- 
pox per 1000 were .... 35* 

In the various German States the mortality 
from smallpox before vaccination was - 
introduced was per 1000 deaths . . 66.5 

After vaccination there occurred . . 7.6 

In Bohemia and Lombardy vaccination re- 
duced the mortality to . . . . 2.0 

Vaccination has not only reduced the mortality 
from smallpox, but also the frequency of smallpox 
epidemics, for previous to the employment of vacci- 
nation; and while inoculation was practised, they 
occurred at the rate of 84 per 100 years ; whereas, 
since the introduction of vaccination, and since in- 
oculation has been declared illegal, the proportion 
has sunk to 21 epidemics per 100 years.* 

Life insurance offices still suffer loss through this 
disease, which might by compulsory vaccination, 
efficiently carried out, be as completely subdued as 
scurvy has been. It is not creditable to this coun- 

* Smallpox and Vaccination ; Letter from Dr. Edward 
Seaton, etc. Parliamentary Paper, 3d May 1853. 



THE HISTORY OF THE INDIVIDUAL. 



123 



try that in 1853 the deaths from smallpox in Eng- 
land still amounted to 3151, but in 1871 the actual 
number of fatal cases of smallpox reached the alarm- 
ing number of 23.126.* We do not now attribute 
such fluctuations to the inscrutable decrees of Pro- 
vidence, since we know that the prevention of these 
and other epidemics rests with ourselves. 

It is satisfactory to turn from this painful subject 
to the statistics which Mr. Griffith Pavies f places 
before us, showing the gradual and sensible decrease 
of the mortality and consequent improvement in the 
expectation of life in this country during the last 
and a part of the present century. The result of 
his researches on this point is thus summed up ; 
taking all ages together, out of the same population 
there died — 



From 


1720 to 1730 


. 


. amounting 1063 


11 


1730 „ 


1740 


. 


ii 


1043 


11 


1740 „ 


1750 


. 


ii 


924 


11 


1750 „ 


1760 


. 


ii 


848 


11 


1760 „ 


1770 


, , 


ii 


840 


11 


1770 „ 


1780 


, . 


ii 


857 


11 


1780 „ 


1790 


. . 


ii 


787 


11 


1790 „ 


1800 


, . 


ii 


747 


11 


1800 „ 


1805 


, . 


ii 


697 


11 


1805 „ 


1810 


, # 


ii 


659 


11 


1810 „ 


1815 


, . 


ii 


612 


11 


1815 „ 


1820 


, . 


ii 


623 



or a reduction of two-fifths in 100 years, which has 
gone on increasing since. Thus Dr. Parr | tells us 

* Registrar-General's Report, 1871, p. 146. 
f Treatise on Annuities, p. 88, by Griffith Davies, F.R.S., , 
London. Published without date. 

J Twelfth Annual Report of the Registrar-General, 1S53. 



124 



THE HISTORY OF THE INDIVIDUAL. 



that at the time when Dr. Price's observations were 
taken, upon which the Northampton tables were 
constructed, the average duration of life in North- 
ampton was 30 years, whereas in 1853 it had reached 
371- years. 

M. Quetelet's * work affords numerous illustrations 
of the diminution of mortality in various European 
communities, which, in part at least, may be attri- 
buted to improved hygiene and to greater domestic 
comfort. The following table, which this author 
quotes from Moreau de Jonnes, though possibly sub- 
ject to some correction, will be studied with interest ; 
it shows the changes that have occurred in different 
countries in the rate of mortality at two distinct 
periods : — 



Name of Country. 


Period. 


One 

Death 

in 


Period. 


One 

Death 

in 


Sweden . 


1754 to 1768 


34- 


1821 to 1825 


45' 


Denmark 


1751 to 1754 


32- 


1819 


45- 


Germany 
Prussia . 


1788 
1717 


32* 
30* 


1825 
1821 to 1824 


45- 
39- 


Wiirtemberg . 


1749 to 1754 


31- 


1825 


45- 


Austria . 


1822 


40- 


1825 to 1830 


43- 


Holland 


1800 


26- 


1824 


40- 


England 


1690 


33* 


1821 


58' 


Great Britain . 


1785 to 1789 


43- 


1800 to 1804 


47- 


France . 
Canton deVaud 


1776 
1756 to 1766 


25*5 
35* 


1825 to 1827 
1824 


39-5 

47- 


Lombardy 
Papal States . 
Scotland 


1767 to 1774 
1767 
1801 


275 
21-5 
44- 


1827 to 1828 
1829 
1821 


31- 
28- 
50' 




K Sur THomme, ? 


rol. i. 


p. 240. 





THE HISTORY OF THE INDIVIDUAL. 125 

But much yet remains to be done ; for when we 
find in some parts of England a rate of mortality 
amounting to 36 per 1000, while there are districts 
in which it falls as low as 15 per 1000, the differ- 
ence, which is demonstrably due to preventable 
causes, is, pro tanto, an indictment against the manner 
in which our sanitary legislation performs its work, 
and cannot be regarded otherwise than as a serious 
imputation upon our much vaunted civilisation. 



CHAPTER VI. 

THE INSUREE'S LIABILITY TO DISEASE. 

It may now be convenient to examine, in order, the 
various indications of a proclivity to disease in the 
individual insuree. The most natural arrangement 
seems to be that suggested by the position of the 
vital organs, and we will therefore successively con- 
sider the head, the thorax, and the abdomen, and 
append such further remarks on the surface and 
extremities as the subject appears to require. 

Previously to going into detailed consideration of 
the different items that appear to deserve attention, 
it may be interesting to the reader to have placed 
before him a summary of the experience of a number 
of first-class insurance offices as to the causes which 
induce claims. It will be seen that although the 
results present many broad features of resemblance, 
they differ in too many points to allow us to take 
their united experience as a standard of comparison. 
The table is in the main that given by Mr. Smee 
jun.,* but we have sought to render the numbers 
more suitable for comparison by adding a calculation 
of their percentage proportion, for which we are in- 
debted to the kind assistance of Mr. Fennell, and the 

* Report of Gresham Life Assurance Society, by A. H. 
Smee jvm., F.C.S. London, 1868. * 





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128 the tnsuree's liability to disease. 

experience of the Briton Life Office, with which we 
have been favoured by Mr. John Messent. 

The cerebral diseases of childhood that chiefly 
affect the future man, even though they have re- 
mained in abeyance for a long time, are of a convul- 
sive character. Convulsions and fits are epileptiform 
diseases which frequently produce in early life the 
subsequent development of true epilepsy. Our client 
may have suffered from the former, owing to stomach 
derangement, worms, teething, or other eccentric irri- 
tation, and never afterwards have manifested the 
slightest tendency to anything of the kind, in which 
case our estimate of his longevity need not on that 
account be affected. But if he subsequently, at or 
before puberty, has shown the slightest trace of tem- 
porary obliviousness or loss of consciousness, the sus- 
picion of an epileptic tendency is aroused. And 
whenever we have the certainty of a single epileptic 
seizure, the life, spite of the modern advances in the 
treatment of this disease, must be considered a dam- 
aged one. If the attacks occur at very long inter- 
vals, or appear to nave been checked altogether, the 
life must still be taken at a high rate, because Ave 
have no certainty that it may not return at any 
period of life, and directly or indirectly abridge life. 
A confirmed epileptic,however good his general health, 
is altogether uninsurable ; not because he will neces- 
sarily die of his disease, but because it exposes him 
to danger by fire and water, by the road and in his 
house, from which it is impossible to guard him. 

There are no satisfactory facts by which we 
can determine a tendency to brain disease in a 



THE INSUREE'S LIABILITY TO DISEASE. 129 

comparatively healthy young person, apart from his 
personal or hereditary history. It is generally con- 
sidered,* and our experience to some extent accords 
with the popular view, that a certain habit of body, 
a short neck, and a plethoric appearance, indicates 
an apoplectic tendency. But we should not think it 
just to refuse such an individual on that plea alone. 
If he exhibited any symptoms of what is called de- 
termination of blood to the head, vertiginous attacks, 
headache, throbbing in the head, and the like, our 
opinion as to his expectation of life would be modi- 
fied, and if he gave the slightest reason for our sus- 
pecting a fondness of liquor, we should advise his 
rejection. During manhood, when the question of 
temperance plays so important a part, indications of 
previous delirium tremens and of present alcoholism, 
may be found in the breath, the furred tongue, the 
dyspepsia, the tremor, the unsteady handwriting, and 
the general mode of expression and habitus of the 
candidate. 

Infantile paralysis f is a condition that may entirely 
have yielded to treatment; but any symptoms of 
paralysis, whether depending upon an abnormal con- 

* Dr. Fleming (Medical Statistics of Life Insurance, p. 47) remarks on this 
point, "The commonly received opinion that persons of peculiar physical 
conformation— those with short necks, full and corpulent habit of body, 
large head and ruddy countenances — are prone to apoplexy and other head 
diseases, is no doubt correct ; but the converse by no means hold so true, as 
is generally believed, for we find many individuals are the subjects of these 
affections of the head, who are free from the above physical characteristics — 
in fact the tall, thin, and athletic are, in my observation, about as often 
attacked as the plethoric.' ' 

tUpon this point Dr. Little kindly favours me with the following remarks: 
— "Infantile paralysis ought to be regarded, even when the individual is left 
with a paralysed muscle or partial paralysis of a whole limb, as less severe 
than any form of pnralysis commencing during adult life, because experience 
shows that the mischief is confined to given molecules in the central organ: 
these molecules may apparently be wholly destroyed and yet the rest of the 
centre perform its work to advanced age." 



130 THE INSUREE's LIABILITY TO DISEASE. 

dition of the brain or spinal cord that are manifested 
subsequently, should be a bar to insurance ; or if, 
under certain favourable circumstances, admissible 
at all, can only be taken at very advanced rates. 

The danger from disease of the brain increases 
with age, and is specially associated with degenerative 
conditions that manifest themselves in the arterial 
system. All indications of premature decay must 
be carefully watched ; and if associated with any 
special symptoms pointing to irregular performance 
of the cerebral functions, they must be held as 
diminishing the prospect of longevity. 

As with all organs, the healthy employment of 
the brain does not tend to impair its vigour. 
Professional men and philosophers, who perform 
much brain work, are generally long lived. But 
when associated with harassing anxieties, the nutri- 
tion gives way, and sometimes apoplexy and paralysis 
set in. Where the emotions come into play largely, 
as in the artist and poet, brain power appears to 
yield more readily to the tax imposed upon it than 
in other professions, for they are not as a body a 
long-lived race. 

About one-eighth of the total mortality is due 
to diseases of the nervous system. In 1871* the 
deaths from all causes amounted to 517,879, of 
which 62,443 were due to this class of affections, 
In 1879 again, the deaths from all causes were 
526,255, and of these 70,245 were due to diseases 
of the nervous system. 

When the proportion of deaths from these causes 
is calculated for 1,000,000 living, in each sex, the 



THE INSUREE'S LIABILITY TO DISEASE. 131 

relation as shown in this table remains essentially 
the same. For comparison we quote the following 
from the Registrar-General's Report for 1881 : — 



ses of Death. 


Deaths to 1,000,000 lih 


zing of each sex. 
Females. 




Males. 


Cephalitis 


333 


258 


Apoplexy- 


566 


567 


Paralysis 


525 


491 


Insanity 


66 


72 


Chorea . 


2 


6 


Epilepsy 


127 


112 


Convulsions 


1118 


793 


Brain Disease . 


334 


244 



It is scarcely necessary to point out that the 
occurrence of a single apoplectic or paralytic seizure, 
even if a good recovery has taken place, ought to 
render such a life uninsurable, on account of the 
great probability of a succeeding attack, which is 
likely to prove fatal.* 

Connected with this subject we must allude to 
sunstroke, a somewhat anomalous condition, patho- 
logically speaking, which occurs in our own country, 
but more frequently among our soldiers and other 
countrymen serving in tropical or sub-tropical 
regions. The individual thus attacked may make a 
complete recovery, but the affection is very liable to 
leave behind it impaired brain power, if not actual 
paralytic or epileptiform oonditions, which mate- 
rially affect longevity. Its influence on life insur- 
ance must be estimated according to the traces that 
remain after sufficient time has elapsed for a cure 
of the primary affection. 

Dr. Fleming presents us with the following table, 

* Dr. Elam (On Cerebria, London, 1872) makes the following statement: — 
"During the last thirty years there has been a large increase of mortality 
from disease of the brain. In the year 18a9 there were 1495 deaths registered 
from this cause; and in 1869 there were 5517. Thus, whilst the population of 
England has increased 30 per cent, the mortality from this cause has been 
multiplied nearly fourfold. 11 Dr Elam only takes the eighth subdivision of 
the Registrar-General's third class, or the unclassified cases of brain disease. 
Had he included the numbers given under the head of Cephalitis, Apoplexy, 
and Paralysis, he would have had even a stronger case. The whole diseases 
of the nervous system are all so intimately allied that for our purpose the 
distinction is scarcely desirable. 



132 the insuree's liability to disease. 

showing the absolute and relative number of deaths 
from diseases of the brain and nervous system occur- 
ring in all England and two large life offices, from 
which it follows that the mortality among the assured, 
due to this cause, is disproportionately large. Such 
evidence ought to act as a special stimulus to the 
medical advisers of insurance offices to search out 
the early indications of cerebral mischief. 



Ages. 


Number of Deaths 
from Diseases of Brain, etc. 


I Percentage of Death* from 
Diseases of the Brain, etc. 


England. 
Average of 
seven years, 
1848 to 1854. 


Gotha 
Society. 


Scottish 

Amicable. 


England. 


Gotha 
Society. 


Scottish 

Amicable. 


15 to 25 


1,469 








5*09 


o-oo 


o-oo 


25 to 35 


1,709 


11 


13 


5-92 


7-33 


11-60 


35 to 45 


2,224 


51 


32 


8-20 


10-30 


15-38 


45 to 55 


2,797 


103 


26 


10-54 


15-91 


14-60 


55 to 65 


3,978 


125 


27 


13.14 


17-40 


19-56 


65 to 75 
Total. 


5,257 


85 


32 


14-48 


18-20 


26-66 


17,434 


375 


130 


9'80 


15-20 


16-81 



In the case ol brain disease, as of other morbid 
conditions, an early manifestation of the scrofulous 
taint would diminish our estimate of the individ- 
ual's liability ; and therefore, although in the 
majority of instances all traces of scrofula have 
disappeared at the time the individual becomes a 
candidate for insurance, the fact of his having 
suffered from some lymphatic disorder in early life 
must not be overlooked. Persistent enlargement of 
the external glands, of the tonsils, scrofulous ulcera- 



THE INSUREE's LIABILITY TO DISEASE. 133 

tion, and caries in childhood, are so many indications 
of impaired nutrition, and not unfrequently give a 
key to later derangements and their probable influ- 
ence upon the duration of life. 

All bona fide disease of the spinal cord must be 
regarded as an absolute bar to insurance, on account 
of its generally incurable character, and its tendency 
to death. Much, however, is called spinal disease, 
especially in women, which ought to be included 
rather in the categories of hysteria and anaemia 
than in the class of diseases dependent upon struc- 
tural changes in the spinal marrow. It does not 
belong to our province to do more than draw atten- 
tion to the necessity of carefully discriminating 
between the genuine and imitative affection. The 
tendency, on the part of the insuree, would be rather 
in the direction of trying to make light of what the 
well-trained practitioner would regard as a more 
serious symptom. He must therefore be on his 
guard not to pass lightly over doubtful points bear- 
ing upon this question. This applies particularly 
to the early symptoms of tabes dorsalis, or, as it is 
now called, locomotor ataxy, the early symptoms of 
which may easily be misinterpreted. If there is 
the least sign of a want of co-ordinating power 
accompanying vague, so-called rheumatic pains, the 
case should be unconditionally rejected ; or if the 
adviser chooses to give the candidate the benefit of 
his doubt, the latter may be required to present 
himself for further examination in six months 5 time, 
when the symptoms will have declared themselves 
sufficiently to allow of an absolute and final decision. 



1^4 THE INSUREE S LIABILITY TO DISEASE. 

According to the Registrar-General's Report of 
1881, thoracic disease carried off in England, in 
1879, 199,800 persons, or nearly one third of the 
total mortality, which was 526,255 ; of these 
37,624 suffered from disease of the heart and great 
vessels ; 51,272 succumbed to phthisis, or pulmon- 
ary consumption; and 110,904 to other pulmonary 
anections. It is not, therefore, surprising that all 
life insurance companies pay especial attention to 
the condition of the thoracic viscera, and that their 
medical officers are expected to seek out every indi- 
cation that the family history, and the antecedents 
and present condition, of a candidate may afford on 
this point. These possess the further melancholy 
advantage of being particularly trustworthy, as 
modern science has done more to facilitate the diag- 
nosis of diseases of the chest than that of the viscera 
of the other cavities of the body. 

We will consider them in their relation to life 
insurance in the order just mentioned. 

1. Diseases of the heart and great vessels. — To 
this class about one-sixth of the total mortality is 
due, a proportion that is much larger than appears 
to prevail in insurance offices, if we may trust our 
own experience, supported as it is by the Analysis 
of Deaths in the Scottish Widows' Fund.* Accord- 
ing to Dr. Begbie, the total deaths among 5989 
persons insured amounted in 30 years to 642, of 
which 53, or about the twelfth part, or $-25 per 
cent, were attributed to lesions of the heart and 

* Observations on the Mortality of the Scottish Widows' 
Fund, by James Begbie, M.D. Monthly Journal of Medical 
Science, January 1847. 



THE INSUREE'S LIABILITY TO DISEASE. 135 

vessels.* The large majority of heart diseases in 
this country are due to the rheumatic poison, which, 
in the form of rheumatic fever or acute rheumatic 
arthritis, is chiefly prevalent during the second and 
third decennium of life ; and though it often passes 
off without physical evidence at the time of inflam- 
mation of the heart or its membranes, rarely leaves 
them altogether unscathed. Cases are common in 
which, when no peri- or endo- carditis has been de- 
tected during the fever, cardiac lesions can be traced 
later in life to the former occurrence of rheumatic 
fever. Moreover, the rheumatic poison is apt to 
cause a recurrence of the disease in the same indivi- 
dual, and no immunity is afforded by an attack, as 
is the case in some febrile disorders. The report of 
rheumatic fever having occurred in a candidate is 
therefore always to be regarded with consideration, 
and should direct special attention to the heart. A 
single well-marked attack, in which the patient has 
been confined to bed for six weeks or more, justifies 
an addition of about seven years ; if the attack has 
recurred, and especially if an hereditary tendency to 
rheumatism also exists, a higher rate is proper, even 
if the heart shows no indication of valve lesion. 
Co-existent defect in the valves, as demonstrated by 
the ear and other physical signs easily recognised by 
the physician, justify the rejection of the life, or its 

*Dl\ Fleming (Medical Statistics of Life Assurance, p. 52) 
finds the percentage of deaths from this cause, compared with 
deaths from all causes, to be, for all England, from 1848 to 
1854, 5-60; for the Gotha Society, 2*79 ; and for the Scot 
tish Amicable, 8*40. 



136 the insuree's liability to disease. 

acceptance only at what most persons would consider 
prohibitory rates. 

All forms of valvular disease may, on the one 
hand, prove the main instruments in causing a rapid 
death, or, on the other, as is well known to every 
physician engaged iii extensive practice, remain for 
an indefinite period subjectively latent. Of all valve 
lesions, aortic regurgitation is the one to which 
sudden death is most frequently due. " I have 
known death," observes Dr. Walshe, in drawing 
attention to this fact,* " take place during the act of 
walking, of eating, of speaking ; while the patient 
was emotionally excited, and, per contra, at a moment 
when he was perfectly calm. And a very singular 
proposition is, that the more pure and uncomplicated 
the regurgitation, the freer the heart from any other 
form of disease, the more likely is the individual to 
be cut off without a moment's warning." We may 
add, in the words of the same author, an important 
practical fact, which the unpracticed ausculator is 
apt to lose sight of, that there is "no direct connec- 
tion between the amount of danger of disease at an 
orifice of the heart and the intensity of an existing 
murmur ; the very weakness of a murmur may, 
indexed, be a fatal sign." 

All well-marked symptoms of cardiac disease, 
whether attributable to rheumatism, to gout, to alco- 
holism, or other causes, a fortiori, if shown to be 
complicated with disturbance of the liver, the brain, 
or kidneys, render a life inadmissible. Where a 
doubt exists, in the interpretation of certain signs, 

* On Diseases of the Heart, 3d edition, p. 389, and seqq. 



TEE INSUREE's LIABILITY TO DISEASE. 137 

the case may be deferred, or a consideration of the 
patient's habits and occupation may assist in estab- 
lishing a reasonably safe conclusion. A single 
examination may not suffice to determine whether 
a murmur is due to anaemia or to organic lesion. If 
the former, it will be removed by proper treatment ; 
but the exigencies of the case must be met by post- 
ponement of acceptance of the policy until the 
murmur has disappeared. One of the forms of 
degenerative disease, wh^ch frequently leads to a 
fatal issue, fatty degeneration of the heart tissue, 
does not always offer physical signs of a marked 
character. It is essentially a disease of advanced 
life due to a retrograde metamorphosis of the tissues. 
A premature arcus senilis, though not a safe guide, 
is sometimes found associated with cardiac softening, 
and at any rate manifests early senility, which may 
diminish the applicant's chances of life. All indi- 
cations of a feeble and irregular circulation, as shown 
by occasional syncope, excited and easily excitable 
pulse, palpitation, pulsatile feelings in different parts 
of the body, are of more or less importance, propor- 
tionate to their severity and frequency. It is 
common to attribute symptoms of this kind to 
" nervousness," and therefore of no importance ; but 
" nervousness " is in itself a sign of constitutional 
debility, which, unless traceable to a temporary and 
accidental influence, as we have known it in a per- 
fectly healthy person to arise from coffee, militates 
against the soundness of the life ; and experience 
tells us that a persistently high pulse, even when 
not apparently connected with any organic disease, 



138 the insuree's liability to disease. 

is often the forerunner of serious mischief either in 
the heart or lungs. A pulse that habitually is at or 
above 90, is unhealthy ; and if, in the adult man, 
the normal pulse of 70, under the examination for 
insurance runs up to 90 and more, it shows an 
emotional impressibility which argues against his 
powers of resisting the inroads of disease. The 
more impressionable character of woman would 
diminish the importance of this test, though there, 
too, it must not be taken as a matter of course. 
The intermittent pulse, again, is one that deserves 
careful consideration ; it may be accidental, from 
the use of certain nervine agents, as green tea or 
tobacco, or only result from the temporary effect of 
an attack of dyspepsia ; but, although there are cases 
on record of persons having enjoyed good health 
with an intermittent pulse throughout their life, it 
is generally associated with imperfect nutrition and 
innervation of the heart, and a sign or forerunner 
of fatty degeneration of the organ, angina, ossifi- 
cation of the arteries and analogous conditions, 
which yield little information to the stethoscope, 
though frequently the cause of much suffering and 
death. 

We should be inclined to regard the irregular and 
remittent pulse as even more significant of malnutri- 
tion of the heart and imperfect circulation than the 
varieties previously spoken of, and even without 
other marked evidence of disease sufficient to justify 
rejection. A similar conclusion must, of course, be 
arrived at where a closer examination of the heart 
itself reveals aortic or mitral insufficiency, or where 



THE INSUREE's LIABILITY TO DISEASE. 189 

percussion and auscultation indicate the presence of 
hypertrophy or dilatation. 

If the medical officer have a doubt as to the state 
of the circulation, and rest does not restore the 
balance, the effect of brisk exercise, as running up 
and down stairs, will generally bring- out the irre- 
gularities more prominently, and determine their 
nature. A simply nervous pulse may lose its irri- 
table character when action takes the place of 
emotion, but an abnormal pulse that depends upon 
organic mischief will exhibit its peculiarities in a 
more marked degree when a greater demand is made 
upon the circulation. 

Excessive slowness of the pulse, i.e., a pulse below 
60, is rarely met with unassociated with serious 
disease. Where it occurs, the medical man must 
exercise his own judgment in the interpretation of 
the symptoms, as it is too infrequent to enable us to 
lay down any specific indications. In the absence of 
any other traceable sign of disease it need not affect 
the expectation of life, and may be set down to idio- 
syncrasy of the insuree. 

It is to be borne in mind by the young practi- 
tioner, that irregular distribution of the arteries are 
by no means infrequent. The radial artery may 
dip down so deeply, or be so small as not to be felt ; 
though the irregular distribution is generally sym- 
metrical, we often find it in one arm and not in the 
other. If one artery cannot be felt, we must look 
for another, and with ji little care 1 lie mystery is 
easily solved. Cases in which the pulse is absent, 
from plugging of the arteries, are not likely to be 



140 the insuree's ltabtltty to disease . 

met with in the examination-room of an insurance 
company. 

Dyspnoea is a symptom that may depend upon 
imperfect performance of the cardiac or pulmonary 
functions. In either case, if not accounted for by 
preceding violent exercise, it shows actual disease 
of the heart or lungs, or a disturbance in the balance 
of the circulation and respiration, which depends 
upon disorder of other organs capable of influencing 
the circulation ; thus we have breathlessness of car- 
diac, of pulmonary, of hepatic, of cerebral, and of 
haemic origin. Its source and nature must be deter- 
mined according to those rules of diagnosis which 
are taught in systematic works on medicine, and by 
the bedside. Where it is due to temporary influ- 
ences, brief rest will speedily remove it, and equable 
respiration and a calm pulse take the place of the 
previous turmoil. 

2. Phthisis.— We have already noted that 53,376 
persons died of pulmonary consumption in 1871 out 
of a total mortality of 517,819, which is close upon 
two-sixths of the mortality from thoracic disease, or 
one-ninth of the mortality from all causes in England 
and Wales. No single disease claims so many vic- 
tims, but it is consolatory to find that it does not 
appear to be on the increase ; for, in 1853,* when the 
deaths from all causes amounted only to 421,097, 
the mortality from phthisis was 54,918, or less than 
the eighth part ; of these, 25,955 were males, and 
28,963 females ; the relative numbers of the sexes 
in 1871 being 26,668 males, and 26,708 females. 

* Registrar-General's Sixteenth Annual Report, p. 124. 



THE INSUREE'S LIABILITY TO DISEASE. 141 

As phthisis is not liable to epidemic fluctuations, we 
may indulge in a hope that this amelioration is due 
to a real improvement in the sanitary and social 
condition of our population. In life assurance the 
claims result large from phthisis, and it is here that 
medical selection tells more according to the man- 
ner in which it is conducted than in any other form 
of disease ; a point that is well brought out by Dr. 
Begbic,* by a comparison of two analyses of the claims 
occurring at different periods in the history of the 
Scottish Widows' Fund ; and also by Dr. Christison's 
Analysis of the deaths in the Standard f The pro- 
portions of the sexes are necessarily inverted, as the 
male lives predominate so largely over the female 
insurces. Thus in the Scottish Widows' fund. J out 
of 72 deaths from consumption, 61 were males and 
11 females. In regard to age, the statistics of Dr. 
Begbie accord with those of the Registrar-General, 
who shows that the largest proportion of deaths occurs 
between 30 and 40. The highest mortality, accord- 
ing to the experience of the Equitable, takes place 
between the ages 40 and 50. 

The following table, extracted from Dr. Chambers' 
Decennium Pathologicum«§ gives further proof that 
youth is not to be regarded as the " harvest time " of 
consumption, and that the proportionate mortality 
from that disease does not vary between the ages of 
15 and 70 as much as is generally assumed : 

* Edinburgh Monthly Journal, Aug. 1853. t Ibid, 

t Observations, etc., by J. Begbie, M.D. 
§ Medical Times, Aug. 14, 1872; and Dr. Fuller's work on 
Diseases of the Chest, p. 350. 





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THE INSUREE'S LIABILITY TO DISEASE. 143 

Iii the chapter devoted to the consideration of 
hereditary transmission, we have dwelt upon the 
special tendency to hereditariness in phthisis. It is 
here, therefore, peculiarly necessary that the family 
as well as the personal antecedents of the future 
policyholder should he carefully investigated. And 
we would warn the medical officer against yielding 
to the popular impression that this inqrfiry becomes 
unnecessary after full manhood is reached, as the 
danger of phthisis continues beyond the age of 60 ; 
an impression that weighs much with boards of 
directors, who will admit evidence of a consump- 
tive taint from puberty to 25, which they frequently 
put aside as insignificant after that period. 

In a person in the slightest degree predisposed,, 
any debilitating influence, especially if it interferes 
with the due oxygenation of the blood and induces-, 
pulmonary congestion, is likely to give rise to phthisis. 
Scrofula in early life, protracted dyspepsia, repeated, 
catarrhs, imperfect convalescence from continued 
and exanthematic fevers, indoor occupation of all 
kinds, especially if carried on in a cramped posture 
and in a close heated atmosphere, an occupation 
entailing the inhalation of dust, grit, or metallic 
particles, are among the numerous causes that lead 
up to confirmed consumption in one or other of its 
varieties. Anxiety, supervening upon any of these 
influences, imperfect food, intemperance, though not 
in themselves adequate to give rise to the deposit of 
tubercle, add much to the power of the previously- 
mentioned incitarnenta mali. In the female, cata- 
menial derangement and gastric ulceration are 



144 1HE INSUHEE ? S LIABILITY TO DISEASE* 

to be specially regarded as forerunners of this 
malady. 

The evidences we look for in the individual, as 
suggesting a suspicion of a phthisical tendency, are, 
slight morning cough, often disregarded by himself; 
frequent hoarseness ; general want of vigour without 
apparent reason; loss of flesh; an habitually quick 
pulse ; the occurrence of haemoptysis ; breathless- 
ness on slight exertion, or still more, an habitual 
acceleration of respiration. The more of these symp- 
toms that are associated in the same person, the 
greater the probability of the approach of phthisis, If 
its actual presence be not already capable of 'detec- 
tion by auscultation aud percussion. The frequent 
recurrence of sore throats is a point deserving of at- 
tention ; if dependent upon chronic enlargement of 
the tonsils, it is a sign of scrofulous taint ; if more 
associated with, irritation and inflammation of the 
larynx and trachea, it shows a delicacy and suscepti- 
bility of the mucous membrane of the part, which 
commonly depends upon the same constitutional in- 
fluences that may lead to phthisis. 

A phthisical habit is often recognisable by the 
transparency of the sclerotic and languid expression 
of the large eye, the liquid eye of the poet ; by the 
clear complexion, with bright patchy redness, or the 
opposite condition of a pale muddy hue ; the easily 
dilated nostril; the general prominence of all the 
bones, owing to the adipose tissue disappearing ; 
the long, thin neck ; the je ne sais quoi of general 
fragility. But it is dangerous to rely too much on 
such indications ; for although in the majority of 



THE INSUREE'S LIABILITY TO DISEASE. 145 

instances the experienced practitioner will not err 
far in his diagnosis of a case by a mere general sur- 
vey, the error in the case before us involves so 
many important interests that he is bound to ascer- 
tain any further evidence that may be at hand. 
Every practitioner will be able to bring to mind in- 
stances in which first cursory impressions proved to 
be fallacious. Among the indications, we would 
single out three — the habitually quick pulse, the 
loss of flesh, and the occurrence of haemoptysis, as 
meriting a few further observations. 

The healthy adult exhibits a pulse ranging about 
70 ; physical or emotional excitement may raise it 
temporarily, but if permanently at or above 80 it 
becomes suspicious, as indicating constitutional de- 
bility ; and if associated with respirations that exceed 
the normal frequency of from 15 to 20 per minute, 
the presumption of the existence of pulmonary in- 
capacity becomes still stronger. A pulse of 100 
and upwards ought to militate against the acceptance 
of any life, unless rest and repeated examinations 
demonstrate its accidental character. The fulness, 
the compressibility, and the strength of the pulse 
must be regarded, as well as the frequency. The 
pulse of phthisis is weak, easily compressible, and 
deficient in volume, as well as frequent. In a per- 
son with full, hard, round pulse, however frequent, 
we should scarcely expect to find the auscultatory 
signs of incipient tubercular mischief. Loss of 
weight is a very constant sien of the premonitory, 
or, as it has also been termed, the pre-tubercular 
stage of phthisis. A healthy adult who enjoys an 



146 the insuree's liability to disease. 

adequate quantity of wholesome food, and takes a 
proper amount of exercise, remains stationary in 
bulk, or increases ; a sudden loss of a few pounds 
even, not accounted for by a change in the habits of 
life, or great bodily fatigue, shows that some abnormal 
influence is at work which materially interferes witli 
nutrition. A weight that is much below the average 
at and after 30, especially if accompanied by an 
accelerated pulse and breathing, undoubtedly justifies 
an increased rate, even if no other signs of a tainted 
constitution are found. Our experience of the poli- 
cies that have become claims have forced the convic- 
tion upon us, that medical men and insurance offices 
would do well to regard these points more seriously 
than is generally done in estimating the expectation 
of life. We have before us an analysis of the 1165 
deaths that occurred in the Briton * Life Company 
from 1863 to 1867 inclusive, and find a mortality 
due to phthisis alone of 218, or 18*8 per cent. No 
argument could impress the necessity of paying strict 
attention to every and the earliest indication of 
phthisical taint than such numbers. 

Haemoptysis is one of those symptoms of lung dis- 
ease which the general public naturally regards with 
much apprehension. If the blood comes up with a 
slight cough or apparently without an effort, if it is 
of bright colour, il it is more or less frothy from the 
admixture of air, the probability is greatly in favour 
of the assumption that it proceeds from the lungs, 
whether the quantity be large or small. Whether 
the haemoptysis precede the deposit of tubercle or 

* Bonus Report for 1867. 



THE INSUREE'S LIABILITY TO DISEASE. 147 

accompanies it is a matter of consequence in the 
treatment and prognosis of the patient's condition, 
but of little importance in the expectation of the 
life of the individual, because he ought, unless in 
very exceptional cases, to be regarded as uninsurable. 
Applicants often try to slur over the inquiry into 
the occurrence of haemoptysis, or they explain it by 
referring it to epistaxis, to haemorrhage from a tooth 
or from the gums, or to sore throat ; and from the 
common difficulty of tracing positive tubercular mis- 
chief at the time of its occurrence, or finding the 
fine crepitus which occasionally enables us to fix the 
exact spot in the lungs from whence it is derived, 
they are not unfrequently countenanced in their 
delusion by their medical attendant. Unless there 
is positive evidence either that the haemoptysis was 
not haemoptysis at all, but haematemesis, or that it 
really did proceed from the nasi-oral or faucial cavi- 
ties, it is safe to act upon the assumption that 
" spitting of blood " was attributable to pulmonary 
mischief, and a forerunner or accompaniment of 
tubercular deposit. " There cannot be a doubt," says 
Dr. Fuller,* " that in the majority of cases in which 
spitting of blood occurs, however small the quantity 
may be, tubercles, in an active or latent state, are 
present in the lungs." It is unnecessary to multiply 
quotations from high authorities on this question ; 
they would all point in the same direction, in accord- 
ance with the daily experience of physicians in active 
practice. 

Although the physical examination of the appli- 
* Diseases of the Chest, p. 259. 



148 THE insuree's liability to disease. 

cant often fails to yield positive evidence of the 
presence of tubercle in the early stage of phthisis, 
the chest should always be bared in all cases of life 
insurance, in order that the configuration of the 
thoracic walls, the rate and mode of breathing, the 
condition of the surface as to complexion, venosity, 
and plumpness, may be accurately determined, as 
well as the evidence obtainable by percussion and 
auscultation. 

The features that would be suspicious of a 
phthisical tendency are a general flattening of the 
chest walls, and especially at the upper front, with 
diminished expansion during inspiration ; a hollow 
supra- and infra-clavicular space ; a bulbous condition 
of the sternal ends of the ribs ; diminished capacity 
of the chest, as indicated by external measurement 
and by the spirometer.* There may be some doubt 
as to how far the spirometer may be used as an 
index of future consumption ; but there appears to 
be no doubt that " a vital capacity " below the aver- 
age indicates a generally feeble constitution, less 
capable of resisting deteriorating influences to which 
the individual may be exposed, as is well shown in 
Dr. Balfour's f contribution to the study of spiro- 

* Dr. Brinton (Medical Selection of Lives, etc.) lays greater 
stress on the employment of the spirometer in life insurance 
examinations than we should be disposed to do. None would 
deny its value if properly us*ed ; but as it requires a certain 
training, not only on the part of the medical man, but still 
more on the part of the examinee, to insure its indications 
being true, it is very apt to yield false results where time is 
an object to be considered. 

t Medico-Chirurgical Transactions, 1860, p. 263. 



THE IXSUREE S LIABILITY TO DISEASE. 



149 



metry. A number of recruits (amounting to 112G) 
were tested by the spirometer, and their subsequent 
medical history, extending on an average to three 
years and five months, carefully watched. The men 
were divided into three classes — 1. Those whose 
vital capacity was more than 10 inches under the 
average calculated for men of the same height by 
Mr. Hutchinson's tables ; 2. Those whose capacity 
ranged between 10 cubic inches under, and 10 above 
the average; 3. Those whose " vital capacity " ex- 
ceeded the average by more than 10 inches. The 
number that died in each class of consumption while 
in the army w r as nearly the same, but a much larger 
proportion of the first class were invalided for this 
cause, — the invaliding having been four times as 
high among men under the average as among the 
others, as shown in the following table ; — * 









^ £ 




Aggregate 
strength. 


By consumption. 


Ratio per 1000 of strength. 
















Died. 
19 


Invalided. 


Total. 


Died. 


Invalided. 


Total. 


Below the average 


1511 


17 


26 


12-57 


11-25 


23-82 


Average 


1145 


14 


3 


17 


12-23 


1-62 


14-85 


Above the average 


1206 


17 


3 


20 


1409 


2-49 


16-58 



* As this table may not be at once clear to some of my 
readers unfamiliar with statistical inquiries, I rcld the follow- 
ing explanation, with which my friend Dr. Balfour has kindly 
favoured me: — u The number of men in each class were under 
observation for different periods of time ; it is therefore neces- 
sary to reduce them to unity to show the annual ratio of deal lis. 
This could be 'done either by multiplying the strength, /.<., 
the numbers over whom the observations extended, by the 
numbers ot years and fractions of years during which they 



150 THE INSUREE'S LIABILITY TO DISEASE. 

The average circumference of the chest above the 
nipples is 38 inches, but considerable variations are 
possible without by themselves indicating disease. 
The signs of quiescent tubercular deposit elicited by 
percussion are a want of resiliency in the chest walls 
in the infra-clavicular regions, a greater or less ab- 
sence of the normal resonance, at the same spot, or 
in the supra-scapular spaces, whicli is specially sig- 

were under observation, or by dividing the total number of 
deaths in each class by the same number, and thus obtaining 
the number of deaths in each year. I have preferred the 
former plan, as I object to talking of the death of a fractional 
part of a man. We talk of this constantly in the ratio of 
deaths per 1000 of strength, but this is merely a proportional 
statement, whereas the other is supposed to be an actual state- 
ment of the deaths. In case this is not quite clear, I would 
put it thus : — The number of men over whom my observa- 
tions extended was in 

1st class . . 416 ~) 

2d „ . . 342 [ 1126 

3d „ . . 368 ) 

but the deaths in these classes occurred in different periods 
of time — 

In the 416 in 3632 years. 
„ 342 in 3-348 „ 
„ 368 in 3'277 „ 
The first would be equal to 1511 men under observation for 
one year, the second to 1145, and the third to 1206 for the 
same period. Or it may be stated thus : — The deaths in each 
complete year under observation were in the 

1st class . . 8-5352 

2d ,; . . 6-8699 

3d „ . . 7-3238 

I think the multiplication of the strength, or numbers under 
observation, looks better than the division of the deaths by 
the period of observation.' 1 



THE INSUREE'S LIABILITY TO DISEASE. 151 

nificative when it is misymmetrical, as it then can 
scarcely be due, unless there is ricketty malfor- 
mation, to anything but consolidation of the sub- 
jacent pulmonary tissues.* The stethoscope exhibits 
more or less defective respiratory murmur, or it 
may be exaggerated at one side while it is feeble on 
the other ; interrupted or jerking respiration, as if 
the process were effected by instalments, is an early 
sign of tubercular deposit ; and an unduly prolonged 
expiratory murmur also justifies a suspicion of con- 
solidation ; if with these symptoms we find rales of 
various kinds, moist or dry, the diagnosis of serious 
mischief is confirmed, but the coincidence of two or 
more of the deviations from the normal standard 

* Dr. Allen * gives the following table of measurements 
of the chest at different heights and the corresponding 
weights, which are slightly below those we have given for 
set. 30 :— 



Height. 




Weig 


ht. 


Circumference of 
Chest. 


5 feet 1 inch 


120 lbs. 4 


34-06 


5 „ 2 inches 


125 


ii 


35-13 


5 „ 3 


ii 


130 


ii 


35-70 


5 „ 4 


11 


135 


ii 


36-26 


5 „ 5 


jj 


140 


ii 


36-83 


5 „ 6 


11 


143 


j' 


37-50 


5 „ 7 


11 


145 


ii 


38 16 


5 „ 8 


V 


148 


ii 


38-53 


5 „ 9 


11 


155 


ii 


39-10 


5 „ 10 


11 


160 


ii 


39-66 


5 „11 


11 


165 


i) 


4023 


„ 


11 


170 


ii 


40-80 



* Medical Examination for Life Insurance. New York, 
1872, p. 67. 



152 THE insuree's liability to disease. 

that have been alluded to ought to entail absolute 
rejection. The character of the voice passing through 
the stethoscope must also he taken into account ; 
whether the vocal resonance be exaggerated or 
diminished, it equally shows an abnormal condition, 
which, occurring at the apices of the lungs, must 
generally be. regarded as indicating tubercle, though, 
of course, there are other anomalies to which the 
symptom may be attributable. The medical man in 
all cases must exercise bis judgment, and not allow 
himself to be determined by a single symptom, unless 
it be of a very precise character, or more definite 
than it usually is in the class of individuals which 
we are reviewing. In all cases, in using the stetho- 
scope as well as in employing percussion, it is neces- 
sary for the medical man to compare both sides of 
the front as well as the back of the chest, and be 
guided by the differences rather than the actual 
character of the physical signs. 

Candidates for insurance are not likely to present 
themselves while actually suffering from any acute 
chest diseases ; if they do so the medical officer 
would necessarily postpone the consideration of the 
case until recovery had taken place. In the lower 
parts of the chest recent pneumonia and former 
pleurisy may leave traces, which need not necessarily 
affect the expectation. In every chest affection the 
possibility of a co-existing consumptive taint increases 
any existing risk manifold, and thus the remains of 
old pleurisy, in checking the movements of the chest 
walls, may assist in developing a morbid tendency. 
In themselves pleuritic adhesions, which even induce 



THE INSUREE'S LIABILITY TO DISEASE. 153 

a certain amount of dulness and flattening of the 
lower chest walls, are of no consequence. Few 
people pass through life without some pleuritic mis- 
chief; the history and antecedents of the examinee 
must be taken into account in determining the exact 
bearing of individual deviations from the normal 
standard. 



CHAPTER VII. 

the insuree's ltabiltty to disease — (Continued). 

The organs of digestion do not take a high rank in 
the army of diseases against which the medical ad- 
viser of an insurance company has to be on his 
guard. According to the table given at page 117, 
the claims resulting from diseases of the digestive 
system yield precedence in point of fatality to zymotic 
disease, tubercular affections, diseases of the nervous 
and of the respiratory systems, with the notable ex- 
ceptions presented by the Scottish offices, one of 
which gives a percentage of 12-5 of claims from 
diseases of the digestive system as against 10*1 per 
cent in the respiratory system, while another exhibits 
a percentage of 11*8 of the former to a percentage 
of 11-3 of claims from tubercular disease ;* the third 

* Upon this point the following remarks of Dr. Fleming 
(Medical Statistics of Life Assurance, p. 59) may throw some 
light. He finds, by his analysis, that there is a considerable 
mortality from diseases of the digestive organs "in the Gotha 
and Scottish Amicable over that of the general population ; 
and when estimated by the deaths from all causes the whole 
assurance societies show an excess, the Gotha and London 
Equitable the smallest." This Dr. Fleming considers to 
be accounted for " by dropsy being entered by the Registrar- 
General in Class II., and by the two societies last named as a 



THE INSUREE'S LIABILITY TO DISEASE. 155 

shows very nearly the same percentage as the digest- 
ive over the respiratory, while it considerably exceeds 
the tubercular class. According to the Registrar- 
General's analysis of the reports* of the fourteen years 
ending in 1871, diseases of the digestive organs occupy 
uniformly the' fifth place in the order of fatality of 
the classes mentioned. And yet their importance 
must not be measured only by the number of deaths 
directly referable to them, for if dyspepsia and dis- 
ease of the liver be not the immediate cause of 
death, they are, even in those diseases to which death 
is attributed, but too often the forerunner or the pre- 
disposing cause. Rheumatism and gout for instance, 
with their various sequelae affecting vital organs, 
alcoholism and its influence on kidneys, heart, and 
brain, are a few of the diseases winch, though pass- 
ing under other names, might reasonably be set 
down among the category under consideration. Dys- 
pepsia must not, therefore, be lightly treated by the 
insurance officer, and unless palpably due to a soli- 
tary error in diet, should be estimated by the rules 
laid down in its bearing on longevity. It is not our 
province to enter into the question of the diagnosis 

distinct disease, while by the Scottish offices it is correctly^ 
referred to the diseases of the organs on which it depended/' 
Still he finds the mortality among the assured from diseases 
of the digestive organs to be considerably in excess of that of 
the general population. "Excluding dropsy, 1144 out of 
12,248, being 9.34 per cent, died of these diseases against 
7*32 in the population of England. Including a third of the 
cases of dropsy, the deaths numbered 1374 out of 12,243, 
being 11*22 against 8*77. " 
* Report for 1871, p. 240. 



156 THE insuree's liability to disease. 

of the different forms of stomach disease, but wher- 
ever there is any trace, such as indicated in syste- 
matic works on medicine, of organic disease of the 
viscus, rejection of the life must follow. 

If there is any history of haematemesis the 
symptoms should be carefully analysed, and though 
it is not of the same importance as haemoptysis, still 
it will always render a life doubtful, and under the 
most favourable ^circumstances justify an addition. 
It is usually indicative of ulceration of the stomach, 
which may have yielded completely, and resulted in 
a perfect cure, as we frequently see in anemic young 
women. All simple ulcers of the stomach will, under 
appropriate treatment, heal, and their cicatrices are 
a matter of common observation in post mortems of 
persons dying of other affections, so that unless the 
digestion is permanently impaired, and there is evi- 
dence of other lesions, they need not call for rejection. 
Ulcer of the stomach* is stated by Dr. Brinton, on 
the authority of an extensive analysis of the published 
experience of various writers, to occur in the propor- 
tion of about five per cent in all deaths, of which one- 
half, approximative^, are to be found in the form of 
healed scars. It occurs twice as frequently in the 
female as in the male sex ; and spirit drinking and 
destitution appear to be its chief causes ; the maxi- 
mum frequency occurring in the spirit drinking 
population of Copenhagen ; while its larger proportion 
hi German hospitals appears due to the greater age 
and more destitute circumstances of their inmates, 

* Brinton, on Ulcer of the Stomach, p. 7. London, 1857. 



THE INSUREE'S LIABILITY TO DISEASE. 157 

than exhibited by the persons usually received into 
English hospitals. 

In candidates for insurance we have especially to 
look for the minor indications of gastric derangement. 
The furred tongue, a glazy irritable surface, an 
aphthous condition of the tongue and buccal mucous 
membrane, recurrent inflammation of the fauces, foul 
breath, especially if tainted with the alcoholic odour, 
an habitually bitter or acrid taste, waterbrash, acid 
eructations, flatulent distention, are among the symp- 
toms which deserve attention, and should at least 
temporarily disqualify for life insurance, until the 
applicant is able to show a clean bill of health. A 
fortiori, any evidence of more serious mischief would 
prove a disqualification, and this view would be 
strengthened if the habits, the mode of life, and the 
occupation, are such as to favour the development of 
dyspepsia. The fat sluggish person is more likely 
to suffer from diseases of assimilation than his thin 
active compeer. Any one leading an out-of-door 
open-air life has, ceteris paribus, a better chance of 
escaping the deleterious effects of repletion than an- 
other who is confined to his room and his chair, and 
does not vitalise his blood and burn off his waste 
tissue by exercise and the inhalation of pure air. 
Among the symptoms of stomach irritation deserving 
special attention, we would mention chronic vomiting, 
or the repeated occurrence of this act, as one indica- 
tive of serious disturbance, and as likely to be the 
forerunner, as it is the frequent accompaniment, of 
organic mischief. In females it is very commonly the 
result of reflex influences, especially proceeding from 



158 the insuree's liability to disease. 

the sexual apparatus, as in pregnancy and disturbed 
menstruation ; but in their case, as well as in the 
male sex, our experience unfortunately tells us to 
examine into the possible abuse of alcohol* which 
circumstances often render it extremely difficult for 
the medical examiner to substantiate, though he may 
have strong suspicions. Where the suspicion exists 
the company ought certainly to have the benefit of 
the doubt. 

Much of what has been said regarding stomach 
disturbance applies also to the influence exerted by 
the liver in determining the estimate of a patient's 
health. The physiological and anatomical rela- 
tions of this organ render it peculiarly liable 
to be implicated in stomach derangement, there- 
fore it is customary to associate stomach and liver 
in, the inquiry suggested to the medical examiner by 
office forms. In cases of dyspepsia it is often diffi- 
cult for the practitioner to disconnect them. It is 
important to remember that what we eat is of less 
consequence in its effect upon the liver than what 
we drink, owing to the immediate passage of fluids, 
and especially of alcoholised liquids, into the portal 
system. Hence this injurious influence is primarily 
and chiefly manifested in this organ, where they set 
up an irr tation, which passes from simple congestion 
and temporary functional derangement to the various 
forms of severe chronic and acute disease, the effects 
of which every pathologist is familiar with. The 
previous occurrence of jaundice, habitual constipa- 
tion, an enlargement of the superficial veins of the 
waist, especially on the right side, former hsema- 

* An excessive use, or rather the abuse, of tobacco induces, besides other 
morbid conditions, chronic, and sometimes very troublesome, vomiting. 



THE INSUREE 7 S LIABILITY TO DISEASE. lo9 

temesis, frequent vomiting, a tendency to haemor- 
rhoids, are features in the history of the applicant 
that would direct special attention to the liver. 
Actual jaundice at the time of application would 
necessitate a postponement, and after its cure, which 
would be speedy if the cause was a catarrhal or some 
similar passing influence, further inquiry should be 
made. The habitual condition of the evacuations 
would assist in the conclusion, and if they had fre- 
quently exhibited a chalky or clayey appearance, the 
inference would be that the liver was not secreting 
a due quantity of bile, and, therefore, imperfectly 
performing its functions. We are as yet far from 
having attained to as correct an estimate of the 
variations in the hepatic secretions as we are able 
to form of the renal secretion, and while even the 
early stages of kidney disease are generally diag- 
nosed with certainty from an examination of the 
urine, we constantly meet with advanced hepatic 
disorder either in the sick-room or in the deadhouse, 
where no such indication was to be found during life. 
There may be a dirty sallow complexion, not 
amounting to actual jaundice, which indicates a 
sluggish performance of the hepatic duties. A con- 
gested state of the congestival vessels, a rubicund 
turgid nose, a full, slow, and sluggish pulse, are often 
associated with the same condition. Owing to the 
anatomical relation of the inferior h hemorrhoidal veins 
and the portal vein, congestion in the vessels of the 
rectum, as manifested in piles and the occurrence of 
haemorrhage per anum,is to be regarded as evidence 
of inactivity of the liver, ycry commonly met with. 



160 THE IXSUREE'S LIABILITY TO DISEASE. 

in intemperate people, and in others leading a seden- 
tary life. Piles alone rarely justify rejection, but 
their nature and extent must be inquired into, and 
their condition would assist in estimating the value 
of other indications. Fistula in ano, in itself a 
curable disease, is often connected with hepatic dis- 
order, and especially occurs in persons of a strumous 
habit of body, and receives importance from these 
circumstances. 

Whether we have reason to suspect the liver or 
not, an examination of the hepatic region is advis- 
able. The normal dullness of the part extends from 
the fifth intercostal space to the lower margin of the 
ribs ; and any material deviation from this relation 
must indicate either that some external pressure is 
exerted upon the organ from above downwards or 
from below upwards, or that there is a deviation 
from the normal proportions in the organ itself. 
Emphysema of the right lung or effusion into the 
right pleural cavity may depress the diaphragm, and 
with it the liver ; or fluid, or tumours in the abdominal 
cavity may push the liver up. Such conditions are 
not likely to come under the consideration of the 
life assurance referee ; if they do, they will be 
readily recognised, and the effect attributed to the 
right cause. But if all the dimensions of the liver 
are altered and no such complications exist, we have 
to determine the nature of the enlargement. There 
is only one form which would not justify complete 
rejection, and that is enlargement depending upon 
simple congestion. This would necessitate the post- 
ponement of the case until the time of cure. Very 



THE INSUREE'S LIABILITY TO DISEASE. 161 

considerable enlargement may be due to this cause, 
but as there is often a difficulty in determining the 
exact nature of liver enlargement, we cannot predi- 
cate the result of treatment with the same certainty 
that we use in many other diseases ; until the liver 
is restored to its normal dimensions, the life is un- 
insurable. 

The conditions that result in a reduction of the 
size of the liver are more difficult of recognition than 
those which lead to hypertrophy. The mapping out 
of the organ by percussion in this case is often ren- 
dered difficult by the condition of the abdominal 
parietes and the state of the intestines, and we shall 
be more generally guided to a safe conclusion by the 
general state and habits of the patient than by the 
physical examination. 

The same may be said of the pancreas, the dis- 
eased conditions of which, in themselves rarely the 
subject of clinic il observation, still more infre- 
quently, if ever, have to be considered in reference 
to insurees. The total number of deaths attributed 
to pancreas disease (with an etc.) by the Registrar- 
General in 1871 is 12 for all England. 

Spleen disease (etc.) claims, according to the same 
authority, 99 fatal cases ; it is not, therefore, of 
much account. The spleen is frequently tempora- 
rily enlarged in fevers of various kinds; but it is only 
the chronic form of enlargement which commonly 
results from ague, a disease which, as we already 
had occasion to point out, is almost extinct in this 
country, that merits a passing observation here. 
The cachectic appearance of a person labouring 



162 THE insuree's liability to disease. 

under enlarged spleen would in itself probably suffice 
to cause his rejection ; but an examination of the 
splenic region in the left hypochondrium would 
readily reveal any enlargement that was capable 
o< being recognised by percussion. We should be 
especially on the alert in respect to this lesion in 
all persons, such as officers, who might have gone 
through malarious diseases, which are the ordinary 
precursors of ague-cake or permanently enlarged 
spleen. 

It is to be feared that incipient Renal Disease is 
not as often recognised by the medical practitioner 
as the means at his disposal permit. The general 
symptoms at the outset are in many cases so. trifling 
that the applicant fails to attribute them to any 
serious indisposition, and there may be nothing in 
his general appearance to draw attention to the 
kidneys. Hence, though the medical adviser would 
have no difficulty in detecting the presence of 
albumen or sugar in the urine were he to apply the 
well-known tests, he shrinks from requiring the 
necessary specimen for fear of appearing unneces- 
sarily minute and pedantic. But as no medical 
man reports on a case for life insurance without 
examining the thorax, and we frequently detect mis- 
chief of which the examinee was unconscious, so no 
report for life insurance ought to be considered com- 
plete without a definite statement as to the condition 
of the urine after examination by the physician. A 
patient, as is well known, thinks a great deal of the 
turbidity and sediment due to the presence of 
lithates, which is of trifling import, but asserts the 



THE INSUREE'S LIABILITY TO DISEASE. 163 

secretion to be healthy as. long as it is clear. It is 
scarcely necessary to insist upon the necessity of 
rejection if albumen or sugar are found ; if either 
symptom be persistently present ; albuminuria is 
more frequently met with as a passing symptom (of 
a congestive condition of the kidneys) than glyco- 
suria ; therefore, if there is any doubt as to the 
nature of the disorder, the applicant may be tem- 
porarily remitted, and his condition be reinvestigated 
after a lapse of, say, six months. The same applies 
to scarlatinal albuminuria, which, though occasionally 
the basis of chronic renal disease, is more commonly 
entirely cured. The amount of albumen in the 
urine is scarcely a question here, for though clinically 
it may be of importance to determine the more or 
less, even a small quantity persistently present justi- 
fies rejection or hazardous rates; the more so, as 
granular disease of the kidneys is often characterised 
by the presence of only a small amount of albumen, 
and is otherwise specially insidious. 

A disorder which is not recognised by the Regis- 
trar-General as a cause of. death, though it indicates 
serious disturbance in the assimilative process, and 
is frequently overlooked in private practice, is 
Azoturia. Characterised by the discharge of an 
excessive amount of urea in the urine, it is often 
the only tangible symptom in vague forms of gastric 
derangement and nervous disease. It is often 
troublesome to deal with, but it yields to treatment, 
unless, as sometimes happens, it passes into, and is 
interchargeable with, diabetes. If the urine exhibit 



164 the insuree's liability to disease. 

a specific gravity of 1030 and upwards, and no 
sugar is found, an excess of urea will almost certainly 
prove to be the cause of the high specific gravity. 
The applicant should, under such circumstances, be 
remitted to his medical adviser, and his acceptance 
be postponed until he is able to present himself with- 
out blemish. 

Present Hematuria is necessarily a disqualifica- 
tion. Its former occurrence would have to be esti- 
mated according to the circumstances under which 
it took place : if all symptoms of renal or bladder 
mischief had disappeared the life might be taken at 
the normal rates, but the causes that gave rise to 
the hematuria, unless in the case of external injury, 
are likely to recur ; and in the case of injury there 
would always be the fear that, as it must have been 
severe to cause direct lesion of the organ, a slighter 
influence than would affect a heclthy person would 
induce acute or chronic disease in the kidney. 

Inflammation of the bladder, or chronic irritation 
of the viscus, is always to be regarded with appre- 
hension, even if, at the time of the examination, the 
symptoms have passed away. Dangerous in itself, 
it is also a cause of renal disease. The same remark 
applies to stricture of the urethra, which, even if 
slight, should be regarded in reference to the possible 
more serious chronic disease of the kidneys to which 
it frequently gives rise later in life. The habits and 
mode of life of the individual may assist materially 
in guiding us to a right conclusion, as intemperance, 
anxiety, or undue exposure, might induce symptoms 
which under more sanitary conditions would not be 
likely to arise. 



THE INSUREE'S LIABILITY TO DISEASE. 165 

Among the lesions of the external parts of the 
body the medical adviser has to consider hernia, 
ulcers, skin diseases, malformations, and the effect 
of former injuries in maiming the individual. 

Hernia, even when easily reducible, is regarded 
as a bar to insurance, unless the applicant consents 
to wear a truss, and even then it is usual to put on 
three years to the life. We do not think that a 
double hernia is in itself a cause for absolute rejec- 
tion, as laid down by Dr. Allen.* Any risk result- 
ing from a single hernia may be increased f when 
both sides of the body are affected, but trusses are 
so well made now-a-days, and the danger of neglect- 
ing their use is sufficiently impressed upon the 
individual, that he need not necessarily run more 
risk in one case than in the other. At all events a 
higher rate might cover it. The medical referee 
should, however, under all circumstances, satisfy 
himself that the applicant really has a hernia, as 
strange mistakes are sometimes made, — enlarged 
glands, hydroceles, tumours, and retained testes 
having been looked Upon and treated as hernia, in 
which cases trusses would be more likely to do harm 
than good. 

Open ulcers render the candidate inadmissible 
until they are healed, but do not occur with much 
frequency in the class of persons, presenting them- 
selves for insurance. Of course the presence of any 
syphilitic taint would affect our judgment still more 

* Medical Examinations for Life Insurance, p 44. 

t A distinguished hospital surgeon whom we have consulted on this point 
even demurs to this conclusion, and has stated to us that he regards double 
hernia, ceteris paribus, as less conducive to danger than single hernia. Mr. 
Callender, of St. Bartholomew's Hospital, has" kindly examined his own 
records bearing upon this question, and finds that double hernia very rarely 
comes under operation, and concludes that it is. therefore, seldom fatal. 
In 50 cases in which he operated he has only twice done so where double 
hernia existed. 



166 the insuree's liability to disease. 

unfavourably ; and for the same reason scars of 
former ulcerative processes must be looked for, and 
their bearing upon longevity determined according 
to their manifest or probable causes. Scars of old 
scrofulous ulcers are very commonly met with, and 
serve as indications to the hereditary or personal 
proclivity of the candidate for assurance, which must 
not be overlooked. Among scars we would specially 
advert to those left by leeches, cupping, and bleed- 
ing. They are frequently forgotten until the medical . 
man notices them ; and the indications they afford 
as to former diseases of subjacent or adjoining viscera 
may assist him in prosecuting his inquiries into the 
past history of the individual, and open out views 
that the defective memory of the examinee might 
fail to offer. 

There are scarcely any skin diseases, excepting 
those showing a constitutional taint, that would per- 
manently disqualify for life insurance. If there is 
any doubt as to their nature, the candidate must be 
remitted to his own medical adviser to be cured, 
which would be especially the case with any second- 
ary syphilitic eruption. Lupus or lupoid disease 
ought to call for a postponement of the case for the 
same purpose. Acne rosacea w r ould attract special 
attention to the habits of the individual, and pro- 
bably on this account render a higher rate desirable. 

Malformations and the results of injury would 
have to be considered in regard to their possible in- 
terference witli the functions of internal organs, and 
also as to wiiether in any way they may give rise to 
danger by preventing the applicant from taking the 



THE INSUREE'S LIABILITY TO DISEASE. 167 

necessary care of himself in every-day life. A deaf 
person, or a blind person, though otherwise in perfect 
health, would be exposed to greater risk from acci- 
dent in and out of his house than any one not 
subject to such defect of the special senses. Blind- 
ness is commonly charged ten years extra, but it is 
not customary to make an addition for deafness. 
The loss of a leg would induce a difficulty of loco- 
motion, which might easily entail further accidents, 
while it also prevents the individual from taking the 
amount of exercise necessary for the preservation of 
health ; the usual addition of three years for this 
defect is scarcely adequate. In all these cases , 
special inquiry should be made as to the cause of 
the loss of limb or sense. Accidents rendering sur- 
gical operation necessary, and diseases followed by 
loss of hearing or sight, may not infrequently be 
traced to intemperance, to culpable carelessness, or 
to hereditary taint, yhich may influence the decision 
as to the rate to be fixed. 

Other morbid conditions of external organs might 
be adverted to as disqualifying for life insurance, or 
necessitating high rates, but some, e.g., fatty degene- 
ration of the muscles, belong rather to the curiosities 
of medical experience, or bear so marked a character 
in abridging life, that it is unnecessary to advert to 
them in detail. For all exceptional cases the medi- 
cal adviser must be guided by his general knowledge 
of medical questions, or, in case of doubt, refer to a 
consultant for a further opinion. 



CHAPTER YIIL 

THE MEDICO-LEGAL ASPECTS OF LIFE INSURANCE. 

A few points, and among them some that especially 
bear upon the medico-legal aspects of life insurance, 
and which have not found a place in the previous 
chapters, remain to be considered. 

It is not customary among respectable offices to 
underbid one another, therefore previous rejection at 
another insurance company militates strongly against 
the acceptance of a life. At the same time, it would 
be cruel not to take a life into consideration that 
proposes in proper form, and it necessarily happens 
not only that different views may prevail as to the 
importance of certain indications, but also that cir- 
cumstances may have occurred since the rejection 
which might justify a favourable interpretation of 
adverse features. In many morbid conditions, time 
effects material improvements, and residuary affec- 
tions, which once threatened danger, may have dis- 
appeared altogether, or have assumed so quiescent a 
form as to present no unfavourable symptoms. Tims, 
a person recently recovered from a pleuritic seizure 
might be deemed ineligible within six weeks of his 
illness, but after a year or more the health might 
and probably would be so perfectly restored as to, 



THE MEDICO-LEGAL ASPECTS OF LIFE INSURANCE. 169 

remove all objections, unless some past indications of 
morbid action had arisen. Another suffering from 
a paralytic affection, consequent upon diphtheria, 
would be unacceptable while there w^as any trace of 
paralysis, but admissible when all nerve symptoms 
had been removed. Instances of this kind might be 
indefinitely multiplied. 

On the other hand, previous acceptance by any 
office does not supersede the necessity of a strict 
scrutiny, when the same individual again proposes 
to insure. The lapse of a few years very frequently 
reveals new features which give the case a totally 
different aspect. Parents, or other relations pre- 
viously in good health, may have died, and their 
fatal illnesses may 'show a taint which was not 
before manifest. The applicant may himself have 
suffered from illnesses exhibiting an hereditary pre- 
disposition that would diminish his expectation, or 
he may have become the subject of morbid influences 
affecting vital organs of a different character, equally 
impairing his prospect of longevity. It is so much 
the custom of English offices to interchange their 
experiences with regard to their policyholders, that 
a certain solidarity exists between them, and a com- 
parison of papers and the contained statements not 
unfrequently exhibits discrepancies, which afford 
considerable assistance in estimating the value of a 
life. Thus, a short time since, a life was proposed 
to an office and reported upon by an examiner of 
eminence. The proposer stated that lie had suffered 
from an attack of rheumatism. A reference to the 
medical attendant proved this to have been a severe 



170 THE MEDICO-LEGAL ASPECTS OF LIFE INSURANCE. 

attack of rheumatic fever, for which seven years 
extra we're charged, but the proposer not agreeing 
to these terms, the proposal was not completed. 
Another equally careful office having taken the life 
at the tabular rates, a comparison of the papers of 
the two companies showed that the proposer, having 
ascertained the weak point in his case, had stated 
in his replies to the second office, that his rheumatic 
fever was " slight rheumatism," and that he had 
required no medical attendant. Applicants even 
unintentionally are apt to exhibit considerable 
obliviousness of matters connected with their own 
health or that of their relations ; it is therefore use- 
ful to be able to remind them of statements- made 
on a former occasion, and to compare accounts given 
at different periods. Wherever there is a suspicion 
that there has been any attempt to deceive and 
make a fraudulent or a highly-coloured statement, 
the application had better be refused altogether, as 
one such intentional error would necessarily more or 
less invalidate all other averments, and in case of 
future disputes, make the company a particeps 
criminis, if it could be shown to have connived at 
the fraud by knowingly accepting a life offered under 
false pretences. 

The physician has an important interest in the 
medico-legal aspect of life assurance, and to esti- 
mate that fully, it may be worth while to refer 
briefly to what the life assurance contract realises, 
and in what terms the contracting parties enter into 
it. In all ordinary, cases a person, either of his own 
accord or at the suggestion of others, comes to an 



THE MEDICO-LEGAL ASPECTS OF LIFE INSURANCE. 171 

insurance company and offers to pay an annuity or 
yearly sum during his life, if the company will 
undertake to pay his representatives a certain sum 
by way of reversion after his death. This being 
\he chief condition of the contract, it remains to 
settle the two sums. The one, the proposer deter- 
mines himself by naming the amount for which he 
wishes to be assured. The other, is fixed by the 
office on the faith of certain statements made by the 
proposer, and of a medical examination to which he 
subjects himself. This examination, however care- 
fully or ably made, must be incomplete without the 
statements, comprising the age, the habits, and the 
personal and family history of the applicant. If 
these statements are not made fairly and truly, one 
of the contracting parties, i.e. the assurance company, 
is induced to enter into the contract in ignorance of 
its exact nature. Of the three subjects just men- 
tioned, the age is capable of positive proof, and 
offices therefore take the statement of the age for 
granted, subject to subsequent evidence of its 
correctness, but particulars as to habits and history 
can only be obtained on the faith of the proposer. 
Some persons are under the impression that the 
undergoing a medical examination relieves them 
from the responsibility of giving false information 
on these points, but this is an error. One of the 
greatest authorities on the law of life insurance* 
quotes the opinion of a learned judge on the subject 
to the following effect : — " Not only must the party pro- 

* A treatise upon the Law of Life Assurance by C. J. 
Bunyon, M. A., p. 30. London, 1854 



172 THE MEDICO-LEGAL ASPECTS OF LIFE INSURANCE. 

posing the insurance abstain from making any de- 
ceptive representation, but he must- observe the 
utmost degree of good faith, uberrima fides. Not 
only is he required to state all matters within his 
knowledge which lie believes to be material to the 
question of the insurance, but all which in point of 
fact are so. If he conceals anything which he knows 
to be material, it is a fraud ; but besides that, if 
he conceals anything which may influence the rate 
of premium, which the underwriter may require, 
although he does not know that it would have that 
effect, such concealment entirely vitiates the policy. 
An entire disclosure must then be made of all 
material facts known to the assured ; and not only 
so, but all representations made by him as to 
material facts must be substantially correct ; and to 
this may be added, that where a representation 
amounts to a warranty, it must not only be substan- 
tially but literally true." 

For convenience, the assurance offices have 
adopted a form, called a declaration, on which the 
requisite information should be given. This form 
is usually annexed to the form of the medical report ; 
and although some offices incorporate it with the 
report, and leave it to the medical examiner to put 
the questions and write clown the answers as they 
are given by the applicant, the majority of the 
offices — while they annex one form to the other, thus 
recognising the necessity that the medical adviser 
should have the applicant's replies before him in 
order to enable him to fill up the other properly, — 
make the declaration a distinct document, which has 



THE MFDICO-LEGAL ASPECTS OF LIFE INSURANCE. 173 

to be signed by the proposer. The declaration 
generally has the following words, or something to 
the same effect, at the foot : — " I declare the above 
statements to be true, and admit them as the basis 

of my contract with the company. 5 ' — The 

questions in this declaration are generally read over 
to the applicant by the physician, and the former 
appends his signature to the answers after they are 
taken clown. 

The modern custom appears to be to put a distinct 
question as to each important disease of ordinary 
occurrence, and the questions doubtless appear to 
the inexperienced to be unnecessarily numerous-. 
But this is quite as much in the interest of the 
proposer as of the office, and to prevent the former 
from forgetting any fact that ought to be^mentioned. 
At the same time the responsibility of giving full 
information rests 'with the proposer, as laid down in 
the quotation previously given from Mr. Bunyon's 
work. He subsequently * adds the following 
authoritative statement : — " If the proposer leads 
the insurers into error, by inducing them to com- 
pute their risk upon circumstances not founded in 
fact, so that the risk actually run is different to 
that intended to be run, the contract is as much at 
an end as if there had been a wilful and false alle- 
gation, or an undue concealment of circumstances.*' 

This being the law, it appears to be the duty of 

the medical examiner to protect both the proposer 

and the office from the results of its being broken. 

In practice, offices rarely dispute the payment of a 

* Loco citato, p. 33. 



174 THE MEDICO-LEGAL ASPECTS OF LIFE INSURANCE. 

policy unless fraud of a most glaring and deliberate 
kind lias been committed ; but it cannot be doubted 
that frauds are practised upon them; and that by the 
withholding or misstatment of certain facts, direc- 
tors are frequently led to pass lives at the ordinary 
rate, when they ought to have been charged an extra 
premium. Take a case like the one previously 
alluded to, where a proposer had been affected with 
rheumatic fever, and who states he had only had a 
slight attack of rheumatism. The former, assuming 
the proposer's age to be 30, would .necessitate an 
extra charge of seven years, while the latter would 
not render an addition necessary. The fraud here 
consists in the value of the difference in the pre- 
miums, or in an assurance for X1000 (say Carlisle 
4 per cent) = £78 : 6s. Or, in the case of a man 
whose mother died of consumption, but who states 
that she died after childbirth, there ought to be an 
addition of 10 years ; and if, in consequence of his 
false statement, he is taken at the ordinary rates, 
the office is defrauded of X 125 : 12s. 

Hence it should be the duty of the medical man 
to impress upon the proposer the necessity of truth 
and exactness, and to cross-examine him on any 
point on which he fails to reply frankly and satis- 
'factorily. Some people think it no harm to benefit 
themselves at the expense of a public company, but 
by the prevailing constitution of assurance societies, 
by which a large majority of the policyholders are 
assured on the system of participating in the profits, 
the injury done affects the members, and each one 
bears his proportion of it. 



THE MEDICO-LEGAL ASPECTS OF LIFE INSURANCE. 175 

Another point in connection with the subject 
under consideration is the relation of the private 
medical attendant. One of the questions addressed 
to a proposer is : Who is your ordinary medical 
attendant? and many controversies have arisen on 
the answer given. It is clear there is room for 
serious fraud here, as experience- has shown. It is 
the custom in one London office always to consti- 
tute the private medical attendant its own examiner 
pro tempore, and to give an additional fee in conse- 
quence. The definition of what constitutes a private 
medical attendant is given in the papers of the office 
in question, thus : — The medical man who has most 
frequently attended the life proposed. 

Life assurance now being widely diffused over 
the country, this plan would be practically adopted 
by many offices, for in small towns and villages 
it must often happen that the medical examiner 
is also the medical attendant of the proposer. 
But in populous towns and districts this is less 
likely to happen, and we are then driven back to 
the question. The reply would necessarily yield the 
name of the practitioner who could give the most 
complete information regarding the proposer. It 
might happen that a candidate for insurance had 
been attended by one medical man for a dangerous 
illness most prejudicial to longevity, and soon after 
by another for some trifling ailment. To name the 
latter as the ordinary medical attendant might be a 
compliance with the. query in its literal sense, but 
certainly not with its spirit. In the case of Everett 
versus Desborougli* it was laid down that a refer- 
. * Bunyon, he. cit. p. 44. 



176 THE MEDICO-LEGAL ASPECTS OF LIFE INSURANCE. 

ence to a person who immediately before the time 
at which the policy is effected has been casually 
consulted for trifling maladies, will not satisfy the 
requisition for a reference to the usual medical 
attendant, although the person who had formerly 
attended may have retired from practice at the 
time. 

We cannot put the matter in a clearer and more 
succinct form than by laying before our readers the 
following further extract from Mr. Bunyon's work ; 
which seems to comprise all the legal bearings of 
the subject : — - 

" The meaning of the question ' Who is your 
usual medical attendant?' was elaborately considered 
in the case lastly referred to {Everett v. Desborongh). 

' What is the grammatical sense of that question?' 
observed the court : ' It is in the present tense.' 
Suppose a person goes to effect a policy on his life, 
who had no medical attendant in the last year ; if 
the answer to the question were, ' I have no such 
medical attendant,' must not that question of neces- 
sity be followed by another, which is, ' Who was 
your former medical attendant?' The terms and 
nature of the question prove that it was designed to 
extract from the person who is the medical attendant 
best able to give an account of her constitution at the 
time ; and if she has no usual medical attendant in 
the precise grammatical sense of the question, it 
appears to me that she is bound to mention who is 
the medical attendant who could give that informa- 
tion. The facts of the case appear to be, that this 
lady had been attended by Mr. Duck, her medical 



THE MEDICO-LEGAL ASPECTS OF LIFE INSURANCE. 177 

man at Bristol, for a considerable time during 
several years, and clown to the time of her marriage 
in December 1832. Previously to her marriage she 
had made one or two attempts to effect a policy on 
her life, and Mr. Duck had been referred to as her 
medical attendant, and on his representations the 
parties with whom it was proposed to effect the 
insurance had declined the risk. She was married 
in December 1832, and it was stated that from that 
time Mr. Duck ceased to attend her, but that a 
gentleman of the name of Day, who had been 
attending her husband, and was the usual medical 
attendant of the family, upon one or two occasions, 
not being called in to attend her expressly, but 
incidentally calling, had given her some slight advice 
of such little note that he had made no memorandum 
of it in his book. When called upon to answer the 
question, she replied, ' Mr. Day,' who being examined 
by the company's agent, said she was perfectly well 
for aught he knew, and that he had never attended 
her professionally at all ; and on trial, that he had 
attended her once or twice : he was not sure that he 
had attended her a second time, but he had once or 
twice given advice to her. The question was left to 
the jury to say whether Mr. Duck or Mr. Day was 
her usual medical attendant ; but it appears to the 
Court, that there was another question behind, 
namely, whether, from the peculiar circumstances 
Under which Mr. Day was introduced to her notice, 
he could be called her usual medical attendant at all. 
It appears to us that it should have been laid down 
to the jury, that, if she was aware that the person. 



178 THE MEDICO-LEGAL ASPECTS OF LIFE INSURANCE. 

whose name she gave could not be the proper person 
to render the account that the defendant wished to 
have of her, it was her duty, to have mentioned the 
circumstance, and to have stated that although Mr. 
Day was a person to* whom they might refer, he 
was not the usual medical attendant, but that the 
usual attendant had been Mr. Duck. To illustrate 
this, suppose Mr. Day had never attended her at all, 
but that when she married she ceased to have any 
medical attendant ; suppose she had answered, ' I 
have no usual medical attendant,' that answer would 
have been followed by the question, ' But had you 
ever any usual medical attendant V She must have 
known that the question was intended to elicit from 
her an answer designating the person who could 
give the best information respecting the state of her 
constitution." 

It is well known that for a long time a contro- 
versy was carried on between the life offices and the 
medical profession on the subject of medical fees. 
It was urged by the former that a proposer for an 
assurance was bound, as a person selling a property, 
to prove Jiis title at his own cost, but that the com- 
pany had the right to make all needful requisitions. 
On the other hand, it was argued that if so, the 
medical man, being in the pay and interest of the 
proposer, was rather his advocate. This contest has 
now ended. The offices admit that the medical man, 
if asked to report, does so in their interest, and 
should be paid by them. It has been suggested 
that the sympathies of the private medical attendant 
are on the side of his patient, but practically, if this 



THE MEDICO-LEGAL ASPECTS OF LIFE INSURANCE. 179 

is the case, it is not found to warp his judgment and 
to induce the return of false statements. If he 
allowed his feelings or prejudices to guide him, it is 
the more necessary that he should be acquainted 
with the clear injunctions of the law as to his duties, 
which are calculated to induce him to be perfectly 
frank, and to make a full statement of everything 
within his knowledge that is at all likely to affect 
what is termed the basis of the contract of life 
-assurance. Anything like reservation clearly jeo- 
pardises the entire transaction, and places the 
policy-holder at the mercy of the company. 

The medical officer of an insurance company has 
an important office to fulfil in examining the claim 
papers ; he has to satisfy himself of the nature of 
the'evidence of death, and he -ought especially to 
inquire into the causes of the fatal issue. In doing 
this he would have three objects in view : first, to 
ascertain that the deatli is attributable to natural 
causes ; second, to determine whether there is any 
discrepancy between the statements of the late 
policyholder, regarding his health and the fatal dis- 
ease ; and third, to extract from each individual 
case any information that may avail him in judging 
of future lives to be submitted to his judgment. 

A death from natural causes excludes the idea of 
suicide, which almost universally invalidates a policy, 
though for our part we are strongly of opinion that 
unless suicide is committed within a certain space of 
time from the date of the first issue of the policy, 
it ought to be regarded like any other accident, to be 
provided for by the rates of insurance. 



180 THE MEDICO-LEGAL ASPECTS OF LIFE INSURANCE. 

The number of suicides iii England in 1871 
was 1495, of which 1103 were males and 392 
females — the average for London alone from 
1846-1850 was about 240 annually, of which 
less than half were females. The proportions 
manifestly vary somewhat in town and country ; 
the total number for London in 1871 was 207 ; 
therefore, considering the vast increase of the popu- 
lation during the last 25 years, this looks like im- 
provement. Suicides occur chiefly in the middle 
ahcl upper ranks of society, whose position and 
property fluctuate much more, involving greater 
anxiety and mental distress than is the case among 
working classes ; hence, although the proportion to 
the entire population is small, the proportion falling 
upon insurance companies, which are chiefly resorted 
to by the former, is comparatively large. This is 
further corroborated by the table quoted from Mr. 
Smee junior, at page 117, where the deaths from 
violence, which includes suicides, are found to 
constitute a high ratio, though this of course is 
imperfect evidence, as we have not the numbers of 
deaths from other causes included under the head 
of violence. Judging by the evidence at our disposal, 
it appears that 5 claims in 1000 are due to suicide. 
Suicide is a direct result of what is termed civilisa- 
tion. The proportion which it bears to the popula- 
tion exhibits a close ratio to the advance of education 
and wealth. It is generally larger in towns than 
in the country. Casper,* the great German medico-' 

* Quoted by Quetelet, Sur l'Homme, vol. ii. p. 147. See 
also two valuable papers on Suicide, by Mr. Jopling, in the 
Assurance Magazine, vols. i. and ii. 



THE MEDICO-LEGAL ASPECTS OP LIFE INSURANCE. 181 



legal authority, gives the following table as the 
result of his inquiries into the frequency of suicides 
in certain towns of importance :■ — 



Number of suicides 
to 1U0,000 inhabitants. 

Copenhagen . 100 

Paris ... 49 


One suicide to number 
of inhabitants. 

1000 

2040 


Hamburg . 


45 


2222 


Berlin 


34 


2941 


London 


20 


5000 


Elberfeld . 


20 


5000 



Quetelet also gives the authority of his imprimatur 
to the following quotation from Balbi,* which the 
reader may like to refer to as bearing upon the 
general social aspect of suicide. The data appear to 
have been collected in or about 1827. The number 
of suicides were in 

Russia, in the proportion of 1 to 49,182 inhabitants. 



Austrian Empire 

France ,. 

Philadelphia ,. 

Prussia ,, 

Baltimore ,, 

Boston 

New York „ 



20,900 
20,740 

15,875 
14,404 
13,656 
12,500 

7,797 



To the list of the sad sequelse to intemperance we 
have also to add suicide, with which it is too often 
found associated. . Dr. Farr has shown that the profes- 
sions peculiarly addicted to drunkenness have more 
than their due proportion of suicides. " Drunkenness," 
he says, " leads to this, but drunkenness is a sort of in* 

* " La Monarchie Francaise compare e aux principaux ttats 
du globe." 



182 THE MEDICO-LEGAL ASPECTS OF LIFE INSURANCE. 

direct suicide, and both are tendencies of the mind 
indulged often from the same motives, and promoted 
by similar causes ; for in drunkenness the wretched 
find not only the gratification of an appetite, but the 
suspension of natural consciousness — in death they 
seek its cessation." 

To pass from these general statistics to the con- 
sideration of the subject immediately before us, it 
may be stated that it is not always easy to deter- 
mine whether an individual has died by his own 
voluntary act or not ; and as insurance companies 
shrink from contesting their liability, although under 
their contract fully empowered to do so under cer- 
tain conditions, owing to the odium which they in- 
cur, unless they are certain of being able to prove the 
correctness of their suspicions, it is tolerably certain 
that a considerable number of claims have been paid 
although life had been terminated by suicide. A 
claim of this kind lately came before us, where morally 
there could scarcely be any doubt that a captain, who, 
without adequate motive, not only refused to leave 
his sinking ship after his mate and all the sailors 
had taken to their boats, but even lay down in his 
berth, and declined urgent solicitations to escape 
from certain death, was guilty of suicide ; yet the 
company consented to pay the policy, owing to the 
conviction that a jury would certainly have looked 
upon him as a martyr and a hero. Most persons 
of any experience in these matters will probably 
recall more marked illustrations of this feature in 
life insurance. 

However, we repeat that we would not even allow 



THE MEDICO-LEGAL ASPECTS OF LIFE INSURANCE. 183 

well-proven suicide to invalidate a policy after a lapse 
of say five years, because it is not to be supposed that 
any one would take out a policy with the view of 
defrauding the company so long beforehand, because 
it is generally desirable to fix a time at which all 
policies become absolutely indisputable, and because 
there is sufficient evidence to justify the belief that 
suicide is generally the consequence of a morbid con- 
dition of the body or the mind, or both. If all in- 
surance companies agreed to adopt some principle of 
the kind, and resolutely acted upon it, the temptation 
to this species of fraud would be removed, and the 
poor survivors would not lose what in these cases is 
often their only stay. 

A certain amount of sympathy cannot be denied 
to persons, who, with the intention of benefiting 
those dear to them, make away with themselves. The 
moral obliquity which is associated, with suicide is 
often to be interpreted as a perversion of one of our 
best feelings ; and the individual who commits the 
act doubtless thinks at times that he is committing; 
an act of self-sacrifice for the good of others. The 
anxiety and distress which commonly lead to self- 
destruction are generally an efficient cause in over- 
throwing the balance of the mind, and if we cannot 
agree with the almost universal verdict of juries, 
that " temporary insanity " palliated the deed ; neither 
can we doubt that before a higher tribunal an inti- 
mate knowledge of the physical and moral circum- 
stances surrounding the case would, in many cases, 
conduce to a verdict that it belonged rather to the 
category of disease than of crime. 



184 THE MEDICO-LEGAL ASPECTS OF LIFE INSURANCE. 

But if a sentiment of pity softens the asperity of 
our feelings with regard ' to the individual who de- 
frauds the insurance company by taking away his 
own life, no expression of condemnation can be too 
strong to apply to those who, for the sake of this 
species of gain, contemplate and carry out the 
destruction of others. Unfortunately, our records 
exhibit many instances of this form of crime ; wives, 
parents, brothers, friends, have been insured and 
murdered for the sake of the proceeds of the policy. 
In the lower ranks of life, burial clubs have been 
repeatedly shown to act as incentives to crime of the 
same kind. All through society, therefore, it4)ehoves 
the medical man to be on his guard, that he may 
detect any indication of a life having been tampered 
with. In this respect he cannot refuse to watch 
over public morality ; and in connection with life in- 
surance, he has the further motive, if any be required, 
that other important interests are committed to his 
charge, and that the discovery of this form of crime 
rests especially with him. 



In conclusion, we would express a hope that we 
have conveyed to our medical readers, throughout, the 
high moral responsibilities which they incur in 
undertaking the work which legitimately pertains to 
them in connection with life insurance. Although 
we have had occasion to advert to the possibility of 
shortcomings in members of the medical profession, 
our general experience, now of many years' duration, 
of the work done by them, justifies the assertion, that 



THE MEDICO-LEGAL ASPECTS OF LIFE INSURANCE. 185 

as a rule they act upon the principle enunciated in 
the passage which Shakspeare puts into the mouth 
of one of his chief characters : 

" Tis not my profit that does lead mine honour ; 
Mine honour, it." 

Life insurance involves interests of the greatest 
importance to the individual and to society ; and 
here as in many other matters affecting the welfare 
of humanity, the medical man is one of the chief 
guardians of social morality and civilisation. The 
more fully he realises the elevated aims that he 
should aspire to, the more he aids his fellow-man 
in his onward progress, and the more he fulfils the 
great obligations which he takes upon himself in 
joining the noblest and the most unselfish of all 
professions. 



APPENDIX. 



188 



CAUSES OF DEATH REGISTERED IN 



i - - 

Causes of Death. 


1852 


1853 


1854 1855 
437,905,425,703 


1856 


1857 


1858 


j 

1859 1 

i 


AH causes . . . -. 


407,135 


421,097 


390,506 


419,815 


449,656 


440,781 


Specified causes . 


394,357 


407,752 


425,645 


413,359 


379, 82h 


409,719 


440,922 


432,476 


CLASSES. 
















1. Zymotic Diseases . 


96,233 


89,564 


117,135 


88,383 


81,375 


93,634 


110,971 


106,645 


2. Constitutional 


83,0-35 


88,216 


83,993 


84,645 


79,500 


81,969 


82,416 


81,788 


3. Local .... 


135,415 


147,138 


143,481 


156,953 


142,761 


151,531 


163,489 


159,686 


4. Developmental 


(56,154 


69,105 


66,996 


69,253 


62,232 


68,668 


69,895 


69,708 


5. Violent Deaths 


13,520 


13,729 


14,040 


14,125 


13,96D 


13,917 


14,151 


14,649 


ORDERS. 

. 1. 

1. Miasmatic Diseases 


















92,305 


85,515 


112,612 


83,726 


77,270 


89,296 1^6,278 


101,699 


2. Enthetic 


889 


874 


1,236 


1,190 


1,069 


1.147| 1,195 


1,273 


3. Dietic .... 


1,676 


1,857 


1,980 


2,087 


1,688 


1,905 


2,112 


2,301 


4. Parasitic 


1,36 J 


1,318 


1,307 


1,380 


1,-348 


1,286 


1,386 


1,372: 


2. 
1. Diathetic 


16,872 


17,601 


16,848 


17,125 


15,668 


16,207 


16,790 


16,433 


2. Tubercular . 


66,163 


70,615 


67,145 


67,520 


63,832 


65,762 


65,626 


65, 355 j 


3. 

1. Diseases of Nervous 


















System 


50,246 


51,509 


51,485 


52,365 


50,0S4 


51,619 


53,961 


54,531 


2. Organs of Circulation . 


12,517 


13,740 


13,488 


14,573 


13,691 


14,802 


16,426 


17,133 


3. Respiratory Organs 


47,400 


56,436 


52,484 


63,820 


52,973 


58,378 


65,516 


59,853 


4. Digestive Organs . 


18,915 


18,749 


18,885 


18,885 


18,710 


19.360 


•19,246 


19,842 


5. Urinary Organs 


3,438 


3,652 


3,770 


4,042 


4,227 


4,202 


4,683 


4,736 


6. Organs of Generation . 


877 


960 


1,014 


1,042 


1,039 


1,069 


1,148 


1,199 


7. Organs of Locomotion . 


1,13^ 


1,227 


1,500 


1,428 


1,329 


1,306 


1,164 


1,285 


8. Integumentary System 


893 


865 


855 


798 


708 


795 


1,345 


1,107 


4 

1. Developmental Diseases 


















of Children 


12,292 


12,541 


12,541 


12,081 


11,586 


12,617 


12,412 


12,300 


2. Adults .... 


2,373 


2,383 


2,125 


2,024 


1,932 


2,042 


2,114 


2,3f4 


3. Old People . 


26,376 


29,130 


26,4H6 


29,714 


23,931 


26.847 


28,509 


27,1-4 


4. Diseases of Nutrition . 


25,113 
13,520 


- 25,051 


25,864 


25,434 


24,783 
13,960 


27,162 


26,860 


27,9b0 


5. 

1. Accident or Negligence ) 

2. Battle j 

3. Homicide . . ! 

4. Suicide [ 


13,729 


14,040 


14,125 


13,917 


12,523 

344 

1,275 

9 


13,056 

338 

1,248 


5. Execution* . . j 














/ 


Violent deaths not classed J 



















Sudden deaths, cause 
















unascertained 


3,591 


4.018 


3,993 


4,139 


3,474 


3,403; 3,096 


2,821 


Causes not specified . 


9,187 


9,327 


8,267 


8,205 


7,204 


6,693 5,638 


5,484 



* The number of persons executed in the several years will not necessarily correspond with that 
are clashed in the latter according to the dates of conviction, while the mini 



ENGLAND FOR TWENTY YEARS— 1852-71. 



189 



1860 


1861 


1862 


1863 


1864 


1865 


1866 

500,689 


1867 


1868 


1869 1870 


1871 


422,721 


435,114 436.566 473,837 


495,531 


490,909 


471,073 


480,022 


494,828 


515,329 '514.879 


414,060 


427,360 


429,000 


465,874 487,732 


482,509 


492,111 


462,939 


473,773 


488,117 


507,921 


5o7,713 


75,849 


87,986 


91,539 


119,731 


118,825 


113,948 


115,972 


90,989 


117,356 


110,601 


120,511 


123,030 


82,088 


84,9^7 


83,024 


84,393 


87,190 


85,504 


89,907 


89,423 


85,340 


86,730 


88,766 


87,072 


171,037 


167,454 


170,651 


174,603 


189,039 


184,877 


192,444 


187,571 


178,634 


199,976 


205,264 


204,362 


70,311 


71,948 


68,842 


71,467 


75,660 


77,806 


76,873 


78,090 


75,475 


74,313 


76,787 


76.256 


14,775 


'14,985 


14,944 


15,680 


17,018 


17,374 


16,915 


16,866 


16,968 


16,497 


16,593 


16,993 


71,304 


83,324 


86,881 


114,538 


113,051 


107,650 


110,059 


84,985 


111,106 


104,670 


114,468 


117,093 


1.252 


1,355 


1,449 


1,578 


1,793 


1,914 


1,893 


1,909 


2,1 1 


2,108 


2,084 


2,056 


2.206 


2,095 


2,149 


2,456 


2,810 


2,957 


2,^88 


2,760 


1 2, £53 


2,645 


2,605 


2,602 


1,087 


1,212 


1,060 


1,159 


1,171 


1,427 


1,132 


1,335 


1,296 


1,178 


1,354 


1,279 


16.404 


16,233 


16,412 


16,651 


17,392 


17,437 


17,482 


17,520 


17,039 


17,511 


17,481 


17,061 


65,684 


68,754 


66,612 


67,742 


69,798 


71,067 


72,425 


71,903 


6^301 


69,219 


71,285- 


70,00 


55,577 


56,625 


55,692 


57,428 


59,627 


'60,264 


61,164 


60,367 


60,174 


61,550 


63,856 


62,453 


18,758 


18,076 


18,709 


19,505 


22,419 


22,272 


22,190 


22,784 


22,558 


24,b99 


25,259 


26,219 


68,408 


64,310 


67,565 


67,280 


75,376 


69,952 


77,249 


72,183 


63,103 


80.397 


82,186 


81,825 


19,718 


20,327 


19,421 


20,'516 


20,969 


21,774 


21,084 


21,006 


21,479 


21,315 


21,853 


21,621 


4,990 


5.222 


5,328 


5,578 


6,104 


6,274 


6,621 


6,933 


6,872 


7,319 


7,503 


7.628 


1,118 


1,129 


1,227 


1,219 


1,294 


1,241 


1,241 


1,316 


1,258 


1.283 


1,298 


1.221 


1,466 


1.624 


1,588 


1,765 


1,860 


1,860 


1.642 


1,747 


1,833 


1,846 


1,893 


1,997 


1,002 


1,141 


1,121 


1,312 


1,390 


1,240 


1,253 


1,235 


1,357 


1,367 


1,416 


1,898 


12,706 


13,116 


12,787 


13,498 


13,921, 


14,360 


14,634 


14,666 


14,334 


14,203 


14,858 


15,176 


2,233 


• 2,168 


2,198 


2,508 


2,607 


2,576 


2,596 


2,461 


2,437 


2,224 


2,510 


2,584 


28,442 


27,373 


26,780 


27,268 


29,49£ 


28,709 


2*,540 


2^,646 


26,050 


27,932 28,889 


28, 03* 


26,930 


29,291 


27,077 


28,193 


29,634 


32,161 


31,097 


3.\317 


32,654 


29,954 30,530 


30,458 


12,991 


13,187 


13,055 


13,772 


15,091 


15,232 


14,886 


14, c 48 


14,715 


14,260 


14,393 


14,961 


377 


320 


418 


399 


412 


443 


480 


3a2 


461 


387 


381 


3>1 


1,365 


1,347 


1,317 


1,319 


1,340 


1,392 


1,329 


1,316 


1,5')8 


1,588 


1,554 


1,49a 


10 


11 


17 


21 


21 


6 


12 


11 


1 I 


8 


7 


4 


32 


120 


137 


1J9 


154 


301 


208 


299 


274 


254 


258 


12 


2,894 


2,697 


2,778 


3,008 


3,321 


3,173 


3/85 


8,^06 2,94" 


3,040 3. ISO 


3,1V. 


5,767 


5,057 


4,788 


4,955 


4,476 


5,227 


4,9u3 


4,62b ] 3,904 


3,671 4,228 


4,011 



in the same years of the "Criminal Returns," inasmuch ns the executions recorded in each year 
bera'in this Table are placed in the years in which the deaths are registered. 



INDEX. 



Accidents, 167. 
Acne rosacea, 166. 
Act of 1870, 10. 

Age, advanced, insurance of, 56. 
,, apparent, 56. 
,, at marriage, 82. 
,, disparity in marriage, 29. 
,, deceptive appearances, note, 

47. 
„ limit of, 26. 
,, of candidates, 56. 
,, premature old, 47. 
Ague, 121. 
Aitken on mortality of army, 65. 

„ on the recruit, 34. 
Albuminuria, 162. 
Alcoholism, 68, 69, 108, 155, 158. 
Allen on chest measurement, 151. 
,, on hernia, 165. 
,, on parturition, 74. 
,, on trades, 63. 
Allen's table, American, 20. 
American table of mortality and 

expectation of life, 20. 
Arcus senilis, 137. 
Armstrong, 120. 
Army, mortality of, 65. 
Arteries, distribution of, 139. 
Assurance, definition of, 10. 
Atavism, 79. 

Attendant, private medical, 175. 
Averages, their value, Chadwick 

on, note, 61. 
Azoturia, 163. 



Babbage quoted, 10, 14. 

Bachelors, 49, 105. 

Bailey on extra premiums, 117. 

,, on longevity, 82. 

,, on peerage, 31, 115. 
Bailey and Day on expectation, 

115. 



Balfour on spirometer, 46, 148. 
Begbie on heart disease, 134. 

,, on mortality, 94. 

,, on phthisis," 141. 
Bengal, mortality of children, 30. 
Bladder, inflammation of, 164. 
Blane medal, 120. 
Blindness, 167. 
Blood relationship in marriage, 

82. 
Bloody flux, 121. 
Braindisease, mortality from, 130,* 

et seqq. 
Brinton on loss of weight, 39. 

,, on medical examinations, 
24. 

„ on spirometer, 148. 

„ on teetotalism. 68. 
Bronchitis, 89. * 

Brown on temperance, 111. 
Bryson on scurvy, 119. 
Bucknill and Tuke on insanity, 95. 
Bunyon, law of life insurance, 175. 



Callexpec on hernia, 165. 
Cancer, hereditary character of, 91. 

,, mortality from, 91. 
Capacity of lungs, 42. 
Carlisle" tables, 15. 
Cerebral diseases, 94, 128. 
Cerebria, Elam on, note, 131. 
Chadwick, E , see note, 61. 
Chambers on phthisis, 141. 
Chest, circumference of, 46, 150. 

,, development of, 34. 

„ examination of, 147. 

„ measurements of, 150. 
Child-birth, mortality from, 72, et 

seqq. 
Children, insurance of, 32. 

,, mortality of, in Bengal, 

30. 



192 



INDEX. 



Christison on medical examina- 
tions, 22. 
,, on painters, 104. 

„ on phthisis, 141. 

Climate, influence of tropical, 30, 
66. 

Collaterals, 88, 
.Colonies, death-rate, 65. 

Commercial travellers, 101. 

Competition of insurance com- 
panies, 108. 

Complexion, 144, 159. 

Conception, 77. 

Consanguinity, 82. 

Consolidation of frame, 81. 

Contagious Diseases Acts, note, 65. 

Continent, expectation of life on, 
19. 

Contract, insurance a, 170. 

Copland quoted, 84. 

Corpulence, note, 38, 129. 

Country population, 61. 



Davies on medical examinations, 

23. 
Davies on reduction of mortality, 
123. 
„ on reduction of rates, 118. 
Deafness, 167. 
Death, causes of, 188. 

„ of the normal man, 48. 
•udden, 137. 
Deaths, examination of, 179. 
Decay, premature, 56. 
Declaration of proposer, 172. 
Decline of life, 47. 
Degeneration, fatty, 39. 

,, of race, 30. 

Deterioration of health, 29. 
Diathesis, 84. 
Diday on syphilis, 85. 
Digestion, disorders of, 154. 
Disease, liability to of insuree, 126, 

et seqq. 
Diseases, hereditary, 75, et seqq. 
Drunkenness and suicide, 53, 181. 
Drysdale, Dr., see note, 61, 63. 
Duration of life, 26, 63. 

„ Babbage on, 17. 

Dyspepsia, its significance, 154. 
Dyspnoea, 139, 144. 



Edmunds on temperance, note, ( 



Elam on cerebria, note, 131. 
Ellis on insanity, 96. 
Engine-drivers," 104. 
Engineers, 105. 
Epilepsy, 98, 128. 
Esquirol on insanity, 96. 
Examination, its value, 22, 171. 

,, mode of, 50, etreqq % 

148. 
Expectation, Bailey on, 115. 

,, Farr "on, 16. 

,, female, 70. 

„ general, 116. 

,, Guv on, 31, 113. 

„ table of, 18. 



Fakr on deaths from parturition, 
71. 
,, on expectation, 16. 
Farr on reduction of mortality, 
123. 
„ on suicide, 181. 
Fat, 35. 

Fatty degeneration, 137. 
Favrer on mortality of children, 

30. 
Feeding of infants, 32. 
Fees, medical^ 178. 
Female expectation, 70, 91. 
„ insurance, 73. 
,, intemperance, 69. 
Fistula in ano, 160. 
Fleming on apoplexy, 129. 

„ on diseases" of digestive 

organs, 154. 
„ on heart disease, 135. 
,, on insurance, 25 
„ table of death, from brain 
disease, 131. 
Forbes on strength of students, 

38. 
Francis quoted. 52, 73. 
Fraud on insurance company, 
medico-legal aspect of, 51, 168, 
et seqq. 
Frauds on insurance companies, 

instances of, 52, 169, 175, 182. 
Fuller on haemoptysis, 147. 
,, on phthisis", 87. 
,, on rheumatism, 93. 



Gaerod on gout, 93, 104. 
Geneva, duration of life in, 63. 



INDEX. 



193 



Gluttony, 69. 

Goethe, note, 80. 

Gout, hereditary character of, 93. 

Graunt's calculations, 12. 

Growth, remarks on, 31, et seqq. 

Guy on expectation, 31, 115. 

„ v on hereditary influences, 76. 

,, on professions, 62, 114. 

,, on sovereigns, 117, 112. 



Habit, phthisical, 144. 
Haematemesis, 156. 
Hematuria, 164. 
Haemoptysis, 146. 

,. " Fuller on, 147. 
Haemorrhoids, 159. 
Hand-feeding of infants, 32. 

„ Dr. Little on, note, 

32. 
Harben on mortality, 64, 105. 
Heart, diseases of, 97, 134. 
Height of English men and English 

women, 36. 
Hereditary influence, 28, 75, 85. 
Hernia, 165. 

Hill, Berkeley, on syphilis, 85. 
Hippocrates on hereditary influ- 
ence, 76. 
Holland on trades, 103. 
Honoraria to medical profession, 

178. 
Hufeland on old age, 49. 

,, on upper classes, 112. 
Hutchinson on height and weight, 
40. 
,, on respiration, 41, 

seqq. 
„ on vital capacity, 44. 



India, rate for, 116. 
Individual, history of, 99, seqq. 
Infants, feeding of, 31. 
Injuries, 166. 
Innkeepers, 66, 105. 
Insanity, mortality of, 95. 
Insurance, board of trade returns, 
11. 

,, definition of, 10. 

,, early history of, 12. 

,, medico-legal aspect of, 

168. 

,, oddities of, note, 13. 

„ security of, 10, 26. 



Intemperance, 52, 66, 106, 108. 

„ and suicide, 53, 181. 

„ effect on expectation. 

106, 108. 
Intermarriage, 29, 80, 83, 96. 

„ Walker on, 80. 



Jacob's lambs, note, 78. 
Jaundice, 159. 
Jews, 96. 

Jonnes on reduction of mortalitv, 
124. 



Kidneys, disease of, 163. 



Lancet, quoted, 101. 

Lead, its influence on health, 104, 

et seqq. 
Leg, loss of, 167. 
Life, decline of, 47. 
„ duration of, 26, 59. 
,, expectation of, 18, 19, 20, 59. 
„ increased duration of, 122, 

et seqq. 
,, increased duration in the 

army, 65. 
,, town and country, 61. 
Life insurance, history of, IS. ftseqq. 
„ morality of, 7 

,, nature of contract, 

10. 
„ statistics of, 11. 

Liharzik on growth, 36. 
Little on infantile paralysis, 129. 
Liver disease, 158. 
Lupus,- 166. 



Malformations, 166. 
Man, normal, 25, seqq. 
Manhood, completion of, 33. 
Mariners, 64, 102, 116. 
Marriage, 81. 

,, disparity of age in, 29. 
Married women, 70. 
Marshall on army mortality, 65. 
Medical examinations, their value, 
21, 170. 
,, men, longevity of, 62. 
,, officers, duties o\\ 50, 179. 
Medico-legal aspects of life insur- 
ance, 168. 



194 



INDEX. 



Merchant service, 120. 
Military men, 116. 
Milne's* Carlisle Tables, 18. 
Miners, 63, 104 
Morgan on insurance, 50. 
Mortality from old age, 49. 

,, from syphilis, 85. 

,, in factories, 103. 

,, in town and country, 61. 

,, of troops, 65. 

,, reduction of, 61, 113, 
124. 

„ tables, 18, 188. 
Morton's mare^ 79. 
Mosaic Law, 82. 
Munro on Eechabites, 110. 
Murder and insurance, 53. 
Muscles, fatty degeneration, 184. 



Naval men, 104, 116. 
Neison on expectation in intem- 
perance, 57. 
,, on intemperance, 106. 
,, on old lives, 56. 
Nervous diseases, table of deaths 

from, 130. 
Normal man, 25. 
Northampton tables, 15. 



Obesity, 38. 

Occupation of insuree, 31, 61, 63, 

100. 
Officers, extra rates for, 116. 
Old age, 47. 
,, lives, 56. 



Paget on cancer, 92. 

Painters, 64, 104. 

Pancreas, disease of, 161. 

Paralysis, 104, 131 

Parish registers, 12. 

Parr, Thomas, 82. 

Parturition, 71. 

Peerage, their duration of life, 31, 

115 
Phillips quoted, 87. 
Phthisis, 140. 

,, early indications of, 150. 

,, hereditary tendency of, 
• 87. J 

,, in insurance, 90. 
Piles, 160. 



Pleurisy, 152. 
Post-office clerks, 102. 

,, insurance, 8. 

Precocity of females, 81. 
Pregnancy, 71. 
Premiums, reduction of, 118. 
Price.'s Northampton Tables, 15. 
Primxparae, 73. 
Printers, 103 

Professions, expectation of, 62. 
Puberty, 80. 

Publicans, short-lived, 106. 
Pulmonary capacity, 42. 
Pulse, its indications, 137, 138, 

139. 
Purdon on loss of weight, 39. 



Quetelet on growth, 34. 

,, on precocious marriage, 

81. 
,, on reduction of mor- 

tality, 124. 
,, on suicide, 181. 

Pace, deterioration of, 30. 
Railway travelling, 64, 102. 
Rate, increase of, 60. 
Rates, extra, 66. 

,, high, of early companies, 14. 

,, increase of, 74, 90, 116, 
117. 

,, reduction of, 118. 
Rechabite Societies, 110. 
Registrar-General's reports, 48, 71, 

85, 91, 120, 123, 131, 132, 141, 

155, 188. 
Rejected lives, 168. 
Reports, importance of, 55. 
Residence, 61. 
Respiration, 40. 
Rheumatic fever, 135. 
Rheumatism, hereditary character 

of, 92, 135. 



Sailoks, 105, 117. 

Scars, 166. 

Scratchley on intemperance, 109, 

107. 
Scrofula and syphilis, 87. 
Scudamore on gout, 93. 
Scurvy, 117. 
Sexes, relation of, 80. 



INDEX. 



195 



Sibley on cancer, 92 
Simpson on parturition, 72. 
Skeleton, consolidation of, 34. 
Skin disease, 166. 
Smallpox, 70, 122. 
Smee's comparative table, 127. 
Smith on nutrition, 32 

,, on mortality in parturition, 
72. 
Soldiers, 34, 116. 
Sovereigns, expectation of, 62, 

113. 
Spinal cord, disease of, 133. 
Spinsters, 105. 
Spirit drinkers, 68, 108. 
Spirometer in phthisis, 148. 
Spirometry, Balfour on, 46. 

,, [ Hutchinson on, 44. 
Spleen, disease of, 161. 
Statements of proposers, 170. 
Statesmen, 114. 

" expectation of, 62. 

Stature, 35. 

Sterility from intermarriage, 83. 
Stomach derangement, 154. 
Stricture, 165. 
Suicide, 179. 
Sunstroke, 131. 
Sycosis, 86. 

SVdenham on ague, 121. 
Syphilis, 29, 86. 

„ and phthisis, 89. 



Tabes dorsalis, 133. 
Table, Carlisle, 58. 
Table of causes of death, 188. 
,, of chest measures, 150. 
,, of deaths in various com- 
panies, 127. 
„ of deaths from intemper- 
ance, 106, 108. 
,, ,, from nervous dis- 

ease, 130, 131, 
132. 
„ ,, from parturition, 

71. 
,, „ from phthisis, 88, 

143. 
„ ,, from scurvy, 119. 

,, of expectation, Davies's, 123. 
„ „ Guv's, 113. 

,, of expectation of life, 113, 
123. 



Table of heights and weights, 37. 
„ „ „ Hut- 

chinson, 41. 
„ of mortality, 15, 114, 124. 
,, of spirometrical indications, 

43, 149. 
,, of suicide, 181. 
,, of vital capacity, 43. 
,, showing influence of rail- 
way travelling, 102. 
,, Williams's, of hereditary 
influence in phthisis, 88. 
Tardieu's cases of fraud, 53. 

,, quoted, 57. 

Teetotallers, 67, 109. 
Temperance, 53, 67, 69, 108, 110, 
111, 129. 
,, Edmunds on, note 68. 

Thompson, Dr. Symes, on corpu- 
lence, 38. 
,, ,, on phthisis, 

90. 
Throat, sore, 147, 150. 
Town population, 61. 
Tractile power, Forbes on, 38. 
Trades, mortality of, 63, 103. 
Travelling, influence of, 101. 
Tropics, influence of, 30, 66. 
Tubercle, mortality from, 91. 



Ulcer of stomach, 143. 

Ulcers of surface, 165. 

United States, mortality in, 20. 



Vaccination, 70, 122. 

Valve disease, 136. 

Velpeau on cancer, 92. 

Violence, deaths from, 105. 

Vital capacity, Hutchinson on, 45, 



,, power, 45. 
Vomiting, 157. 



Walford, quoted, 10, 12, 14, 62. 

,, on expectation, 58, 113. 

Walker on intermarriage, 80. 
Walshe on heart disease, 136. 
War rate, 116. 
Ward, quoted, 56. 
Wasting, 38. 
Weight, loss of, 146. 



196 



INDEX. 



Weight, normal, 34, 36. 

,, sudden change of, 38, 39. 

„ variation of, 37, 39, 146. 
Weights, comparative, 37. 

,, of male and female, 33. 
Welton, note, 63. 
Whitehead on syphilis, 86. 



Whitehead quoted, 80. 
Williams on phthisis, 88. 
Willich on expectation, 58. 
Willich's tables, 19. 
Wives, insurance of, 72. 
Women, married, 70. 
Wood on insanity, 95. 



